title: Influence of a dedicated paediatric cardiac intensive care unit on patient outcomes.
abstract: BACKGROUND
  The impact of a designated intensive care unit (ICU) for postoperative cardiac care in children is not clear. In our hospital (in the USA), we started a new Paediatric Cardiac Surgery programme 5 years ago, in September 2004. During the first 2 years of the programme, postoperative care was accomplished within the general paediatric ICU (PICU or c-ICU). Subsequently, in September 2006, a dedicated cardiac ICU (d-ICU) was established. We looked at our experience during these two periods to determine whether the designation of a separate ICU affected outcomes for these children.
  
  
  METHODS
  We obtained Institutional Review Board (IRB) approval to review the medical records for all postoperative cardiac admissions to the ICU during the first 4 years of the programme (September 2004-September 2008). Variables collected included age, gender, diagnosis, type of cardiac surgery, Risk Adjustment for Congenital Cardiac Surgery, version 1 (RACHS-1) classification, ventilator use, hospital stay, invasive line infections, ventilator-related infections, wound infections, need for cardiopulmonary support, return to the operating room, re-exploration of the chest, delayed sternal closure, accidental extubations, re-intubation and mortality rates. These variables were summed and compared for the combined PICU and the dedicated paediatric cardiac ICU.
  
  
  RESULTS
  There were 199 cases performed in the first 2 years compared with 244 in the following 2 years. We saw a statistically insignificant increase in the number and complexity of cases during the second period (p = 0·08). However, morbidity declined as evidenced by the decrease in wound infection (p < 0·001) and need for chest re-exploration (p < 0·001). In addition, mortality declined from 7 of 199 (3·5%) to 2 of 244 (0·8%). p < 0·04 and less children required resuscitation (p < 0·01).
  
  
  CONCLUSIONS
  We believe the designation of a specific area for postoperative cardiac care was instrumental in the growth and development of our cardiac programme. This rapid change accomplished several crucial elements that lead to accelerated improvement in patient care and a decline in morbidity and mortality.
authors: Congenital Heart Institute at Arnold Palmer Hospital for Children, Orlando, FL 32806, USA. mahereldadah@yahoo.com
authors: Maher
authors: M
authors: Eldadah
authors: Sheryl
authors: S
authors: Leo
authors: Kristina
authors: K
authors: Kovach
authors: Ivan
authors: I
authors: Ricardo Argueta Morales
authors: Julie
authors: J
authors: Pepe
authors: Harun
authors: H
authors: Fakioglu
authors: William
authors: W
authors: Decampli
mesh_terms: D006348:Cardiac Surgical Procedures / Q000534:rehabilitation*; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric / Q000458:organization & administration*; D011182:Postoperative Care / Q000379:methods* / Q000451:nursing*; D016896:Treatment Outcome; D014481:United States