title: A specialized post anaesthetic care unit improves fast-track management in cardiac surgery: a prospective randomized trial.
abstract: BACKGROUND
  Fast-track treatment in cardiac surgery has become the global standard of care. We compared the efficacy and safety of a specialised post-anaesthetic care unit (PACU) to a conventional intensive care unit (ICU) in achieving defined fast-track end-points in adult patients after elective cardiac surgery.
  
  
  METHODS
  In a prospective, single blinded, randomized study, 200 adult patients undergoing elective cardiac surgery (coronary artery bypass graft (CABG), valve surgery or combined CABG and valve surgery), were selected to receive their postoperative treatment either in the ICU (n = 100), or in the PACU (n = 100). Patients who, at the time of surgery, were in cardiogenic shock, required renal dialysis, or had an additive EuroSCORE of more than 10 were excluded from the study. The primary end points were: time to extubation (ET), and length of stay in the PACU or ICU (PACU/ICU LOS respectively). Secondary end points analysed were the incidences of: surgical re-exploration, development of haemothorax, new onset cardiac arrhythmia, low cardiac output syndrome, need for cardio-pulmonary resuscitation, stroke, acute renal failure, and death.
  
  
  RESULTS
  Median time to extubation was 90 [50; 140] min in the PACU vs. 478 [305; 643] min in the ICU group (P < 0.001). Median length of stay in PACU was 3.3 [2.7; 4.0] hours vs. 17.9 [10.3; 24.9] hours in the ICU (P < 0.001). Of the adverse events examined, only the incidence of new onset cardiac arrhythmia (25 in PACU vs. 41 in ICU, P = 0.02) was statistically different between groups.
  
  
  CONCLUSIONS
  Treatment in a specialised PACU rather than an ICU, after elective cardiac surgery leads to earlier extubation and quicker discharge to a step down unit, without compromising patient safety.
  
  
  BACKGROUND
  ISRCTN71768341. Registered 11 March 2014.
authors.forename: Stefan
authors.initials: S
authors.lastname: Probst
authors.forename: Christof
authors.initials: C
authors.lastname: Cech
authors.forename: Dirk
authors.initials: D
authors.lastname: Haentschel
authors.forename: Markus
authors.initials: M
authors.lastname: Scholz
authors.forename: Joerg
authors.initials: J
authors.lastname: Ender
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage; D006348:Cardiac Surgical Procedures; D045422:Continuous Positive Airway Pressure / Q000379:methods* / Q000706:statistics & numerical data; D003363:Cost Control / Q000379:methods; D017558:Elective Surgical Procedures; D006801:Humans; D007362:Intensive Care Units / Q000191:economics / Q000706:statistics & numerical data; D007442:Intubation, Intratracheal; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data*; D017063:Outcome Assessment, Health Care / Q000191:economics / Q000706:statistics & numerical data; D061214:Patient Safety; D010880:Piperidines / Q000008:administration & dosage; D010892:Pirinitramide / Q000008:administration & dosage; D011182:Postoperative Care / Q000191:economics / Q000379:methods* / Q000592:standards; D011183:Postoperative Complications / Q000453:epidemiology*; D011446:Prospective Studies; D000077208:Remifentanil; D013997:Time Factors
chemical_list: D000701:Analgesics, Opioid; D010880:Piperidines; D010892:Pirinitramide; D000077208:Remifentanil