Cardiothoracic intensive care: operation and administration.

Abstract

The cardiothoracic surgery intensive care unit (CTICU) has evolved as a separate entity from the general surgical intensive care unit as management for cardiac surgery patients has become streamlined and algorithm driven. Critical care is best managed when the service is designed for a homogeneous population with a circumscribed set of medical and surgical issues. The repetition involved with the subspecialty care allows health care providers such as primary care nurses, nurse practitioners, physician assistants, and other ancillary services to become appropriately focused on issues pertinent to this population. The goals of the CTICU include the attainment of rapid and safe recovery from surgery and anesthesia despite decreasing resources, increasing patient age and comorbidity, and increasing complexity of the operative procedure. The coordinated and systematic approach to the postoperative cardiac surgery patient under the direction of a staff physician offers the most effective opportunity to achieve these expectations at this time. The traditional model of staffing by a physician with responsibilities that conflict temporally with the immediacy often needed for the postoperative care of cardiac patients may expose patients to unnecessary risks. A responsible physician should be available in the CTICU, especially during the immediate postoperative period when physical assessment and direct hands-on involvement are essential. In an era when the operative team (ie, cardiac surgeon and cardiac anesthesiologist) must return to the surgical suite soon after the patient arrives in the intensive care unit, the presence of a physician dedicated to postoperative medical and surgical management becomes mandatory. According to the Joint Commission on Accreditation of Healthcare Organizations, "Each special care unit is properly directed and staffed according to the nature of the special patient care needs anticipated and scope of services provided." The assignment of staff is designed to match experience with patient acuity.