• G-W Hao, G-G Ma, B-F Liu, X-M Yang, D-M Zhu, L Liu, Y Zhang, H Liu, Y-M Zhuang, Z Luo, and G-W Tu.
• Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai 200032, PR China.
• Med Intensiva. 2020 Jan 1; 44 (1): 27-35.

ObjectiveTo compare outcomes between intensivist-directed and cardiac surgeon-directed care delivery models.DesignThis retrospective, historical-control study was performed in a cohort of adult cardiac surgical patients at Zhongshan Hospital (Fudan University, China). During the first phase (March to August 2015), cardiac surgeons were in charge of postoperative care while intensivists were in charge during the second phase (September 2015-June 2016). Both phases were compared regarding successful extubation rate, intensive care unit (ICU) length of stay (LOS), and in-hospital mortality.SettingTertiary Zhongshan Hospital (Fudan University, China).PatientsConsecutive adult patients admitted to the cardiac surgical ICU (CSICU) after heart surgery.InterventionsPhase I patients treated by cardiac surgeons, and phase II patients treated by intensivists.Main Variables Of InterestSuccessful extubation, ICU LOS and in-hospital mortality.ResultsA total of 1792 (phase I) and 3007 patients (phase II) were enrolled. Most variables did not differ significantly between the two phases. However, patients in phase II had a higher successful extubation rate (99.17% vs. 98.55%; p=0.043) and a shorter median duration of mechanical ventilation (MV) (18 vs. 19h; p<0.001). In relation to patients with MV duration >48h, those in phase II had a comparatively higher successful extubation rate (p=0.033), shorter ICU LOS (p=0.038) and a significant decrease in in-hospital mortality (p=0.039).ConclusionsThe intensivist-directed care model showed improved rates of successful extubation and shorter MV durations after cardiac surgery.Copyright © 2018. Publicado por Elsevier España, S.L.U.

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