心脏外科患者ICU再入院:一个值得思考的问题

Jaffrey Kalaiselvan, R. Kashav, Jasvinder K Kohli, R. Magoon, Iti Shri, V. Grover, Narender Singh Jhajharia
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引用次数: 0

摘要

在过去的几十年里,心脏外科实践有了显著的进步,有助于心脏手术后快速追踪和增强恢复(ERACS)。综上所述,在这一高危患者队列中,再入住重症监护病房(ICU)会带来显著的发病率-死亡率负担。作为同样的延伸,对初级ICU出院后再入院倾向的综合评估得到了高度重视。然而,机构围手术期实践的可变性和研究的复杂性使我们对再入院的异质性结果的理解复杂化,这与患者和组织因素错综复杂地联系在一起。此外,最近关于ICU再入院的讨论只有在与心脏外科快速跟踪实践紧密结合时才能呈现全面。从一个更积极的探索问题,预防性的前景可能会减轻ICU再入院的更大问题的一部分。在此,鉴于关于心脏康复对最相关的再入院原因的积极影响的新兴文献,重点心脏康复计划可以发挥潜在的作用。因此,该索引综述文章旨在解决心脏外科ICU再入院的问题,强调其规模和负担,原因和风险因素,以及研究的复杂性,同时在当前ERACS和心脏康复的背景下审议该主题。
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ICU Readmission in Cardiac Surgical Subset: A Problem Worth Pondering
Abstract Over the past decades, there have been noteworthy advancements in the cardiac surgical practice that have assisted fast-tracking and enhanced recovery after cardiac surgery (ERACS). With that said, intensive care unit (ICU) readmission in this high-risk patient cohort entails a significant morbidity–mortality burden. As an extension of the same, there has been a heightened emphasis on a comprehensive evaluation of the predisposition to readmission following a primary ICU discharge. However, the variability of the institutional perioperative practices and the research complexities compound our understanding of this heterogeneous outcome of readmission, which is intricately linked to both patient and organizational factors. Moreover, a discussion on ICU readmission in the recent times can only be rendered comprehensive when staged in close conjunction to the fast-tracking practices in cardiac surgery. From a more positive probing of the matter, a preventative outlook can likely mitigate a part of the larger problem of ICU readmission. Herein, focused cardiac prehabilitation programs can play a potential role given the emerging literature on the positive impact of the former on the most relevant readmission causes. Therefore, the index review article aims to address the subject of cardiac surgical ICU readmission, highlighting the magnitude and burden, the causes and risk-factors, and the research complexities alongside deliberating the topic in the present-day context of ERACS and cardiac prehabilitation.
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审稿时长
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