European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Jan 2004
Fast-tracking revisited: routine cardiac surgical patients need minimal intensive care.
Following cardiac surgery, patients are transferred from the operating theatre to intensive care. This clinical environment has one nurse per patient and facilities for mechanical ventilation. Patients are kept in this setting until the following day. This practice has been challenged with early extubation of patients. At our institution we have established a fast-track policy including the following features: (1) patient selection; (2) operating list scheduling with fast-track patients first; (3) anaesthetic tailored to early extubation; (4) methodical procedure with warm cardiopulmonary bypass; (5) removal of the arterial line; (6) transfer from intensive care to a separate high dependency unit ('step-down') on the day of operation, where the ratio of nurse to patient is one to three and there are no ventilatory facilities and no invasive monitoring; or (7) to keep these patients on ICU but decrease the nurse to patient ratio. ⋯ This study demonstrates that transfer of appropriate patients to a high dependency area from intensive care following cardiac surgery is safe. It allows intensive care beds to be used by more than one patient each day and allows significant cost savings by reducing the nursing ratio per patient.
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Eur J Cardiothorac Surg · Jan 2004
Surgical nurse assistants in cardiac surgery: a UK trainee's perspective.
To assess the impact of surgical nurse assistants on surgical training based on a comparative audit of case-mix and outcome of coronary revascularizations assisted by surgical nurse assistants vs. surgical trainees. ⋯ Surgical nurse assistants can be used effectively in low-risk cases without compromising postoperative results. However, initiatives to tackle the EWTD should be focused on areas that do not compromise the training needs of junior surgical trainees. An intermediate grade between the present senior house officer and registrar grades could be a way forward.
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Eur J Cardiothorac Surg · Jan 2004
Analysis of thoracic aortic blood flow during off-pump coronary artery bypass surgery.
The non-invasive monitoring of thoracic aortic blood flow (TABF) during off-pump coronary artery bypass (OPCAB) surgery is becoming more commonly used and proved to be invaluable in the early detection of haemodynamic compromise due to heart displacement. The aim of this study was to analyze the changes in the TABF during OPCAB using transoesophageal Doppler and compare them with the changes observed by other monitoring methods as cardiac output, invasive pulmonary and radial pressures and mixed venous oxygen saturation. ⋯ Low TABF occurred without significant changes in the measurements obtained from classic haemodynamic monitoring methods during OPCAB surgery. This finding could be of vital importance in helping improve the monitoring and consequently the management of patients undergoing OPCAB surgery.