Fast-track program in cardiovascular surgery

Objective

To study a group of patients included in a fast-track program after cardiovascular surgery concerning the medical, economical, psychological and dynamic conditions of the protocol in the ICU.

Materials and methods

Seventy patients operated on from August to December 2000 were included. Inclusion criteria were: age, no operation events, hemodynamic stability and no co-morbidity. Early extubation was achieved using bendiazepan antagonist (Flumazenil) and respiratory physiotherapy with noninvasive ventilation (CPAP or BIPAP). ICU discharge was on the first postoperative day.

Results

Among the 70 patients, 57% were male with a mean age of 56.2 years. With regard to the type of operation, 74% were submitted to coronary bypass surgery, 17.1% to valve surgery, and 8.9% to another type of operation. The average extubation time was 153 min; 22% had hypertension and 2.8% were reintubated. From the psychological point of view, 95% of patients considered the shorter ICU stay satisfactory. With regard to the dynamics of the ICU, there was a 50% decrease in duration of ICU stay, and an increase of 30% in patient admission and a reduction of 40% in cost. No patient had significant clinical complication and no one was readmitted.

Conclusion

A reduction of ICU stay was possible in selected patients with satisfactory medical and psychological conditions, as well as cost containment and greater availability of beds.