WHEN IS ICU CARE WARRANTED AFTER CAROTID ENDARTERECTOMY - A 3-YEAR RETROSPECTIVE ANALYSIS

The purpose was to determine the valid indications for Surgical Intens ive Care Unit (SICU) admission after carotid endarterectomy (CEA). The indications for admission to the SICU after CEA were studied over a 3 -year period (4/89-3/92). Absolute indications for ICU admission (AIA) included mechanical ventilation, a pulmonary artery catheter, and int ravenous vasoactive or antiarrhythmic drug infusion. Patients were gro uped according to presence of an AIA (Group A), absence of an AIA and a one day SICU length of stay (Group B), or absence of an AIA and a SI CU length of stay > 1 day (Group C). A total of 305 patients were admi tted to the SICU during the study. There were 55 patients in Group A. Of the 250 patients without an AIA, 239 were in Group B and 11 compris ed Group C. Group A patients had a significantly higher severity of il lness compared with Groups B and C (P < 0.05). Group B patients demons trated no need for SICU care. Group C patients received ongoing SICU c are due to postoperative neurological changes, arrhythmias, angina, in cisional bleeding, vocal cord paresis, and unavailability of a ward ro om. None of these conditions was life-threatening and only vocal cord paresis would have required SICU admission. Two patients in Group A di ed; no patients died in Group B or C. Only patients with an AIA, perio perative neurological changes, or early hemodynamic instability requir e SICU admission after CEA. An observation period in the recovery room allows for selection of nearly all patients who will eventually requi re SICU care.