DOES MODERN CARDIAC-SURGERY REQUIRE CONVENTIONAL INTENSIVE-CARE

We considered that, with modern perfusion equipment and mildly hypothe rmic cardiopulmonary bypass, protracted post-operative ventilation in an intensive care unit (ITU) is no longer required after most cardiac operations. We used a three-bedded cardiac recovery area (CRA) within the operating suite for 1,000 patients between January 1990 and June 1 991. Forty-five patients with special needs were managed in the ITU. T he time to extubation (T50%; range) for coronary bypass, aortic valve, mitral valve, and double-valve patients was 2.0 (0 - 42), 2.5 (0 - 12 ), 3.0 (0 - 15), and 3.0 (1 - 36) hours, respectively. Recovery beds w ere re-used allowing 5-6 operations daily. The difference in nursing s taff complement for a CRA versus ITU bed was 4.5/7.8. Patient manageme nt was by nurse specialists supported by cardiac surgeons. Interventio n by cardiac anaesthetists or intensivists was limited to specific ven tilatory problems or renal failure. The early extubation policy failed in ten patients (five coronary, three aortic, one mitral and one doub le-valve patient) through poor pre-operative respiratory function, lef t ventricular failure or intra-operative events. The overall mortality in CRA was 1.4%. The mean duration of post-operative stay was 7 days (range 5 - 12). We conclude that a CRA staffed by nurse practitioners provides a safe and effective alternative to the anaesthetist-managed ITU. A rapid turnover of CRA beds removes the constraints of ITU bed a vailability.