Clinical Physiology of Circulation

ISSN 1814-6910 (Print)
ISSN 2410-9134 (Online)

 

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery


Issue's catalogue ➤ КФК. 2022; 19 (3): 193-286 ➤ Эволюция стратегии ранней активизации: развитие, формирование, взгляд в будущее. Часть 1

The evolution of fast-track recovery: development, establishment, prospects. Part 1

Authors: Diasamidze K.E., Yalieva L.K., Mishin G.M., Chitorelidze M.A.

Company:
Bakoulev National Medical Research Center for Cardiovascular Surgery, Moscow, Russian Federation

E-mail: Сведения доступны для зарегистрированных пользователей.

DOI: https://doi.org/10.24022/1814-6910-2022-19-3-211-220

UDC: 616-085

Link: Clinical Physiology of Blood Circulaiton. 2022; 3 (19): 211-220

Quote as: Diasamidze K.E., Yalieva L.K., Mishin G.M., Chitorelidze M.A. The evolution of fast-track recovery: development, establishment, prospects. Part 1. Clinical Physiology of Circulation. 2022; 19 (3): 211–20 (in Russ.). DOI: 10.24022/1814-6910-2022-19-3-211-220

Keywords:  cardiac surgery early activation factors preventing early activation extubation on the operating table elderly patients improved recovery after cardiac surgery

Received / Accepted:  15.07.2022 / 17.09.2022

Download
Full text:  

Abstract

Fast-track cardiac care is a multimodal strategy with the ultimate aim of significant reduction in the duration of postoperative ventilation and early extubation within six hours after cardiac surgery. Fast-track treatment results in a decrease in intensive care unit stays and subsequently a possible reduction of hospitalization cost without compromising patient's safety.

The review highlights the development of the “fast-track” strategy, reflects the scientific debate about the prolonged postoperative mechanical ventilation and outlines the prospects for the development of the “fast-track” concept. In this paper the authors summarize international experience in implementation of an early extubation protocol and present results of the impact of time to extubation on the pace and effectiveness of rehabilitation of cardiac patients.

References

  1. Wong W.T., Lai V.K., Chee Y.E., Lee A. Fast-track cardiac care for adult cardiac surgical patients. Cochrane Database Syst Rev. 2016; 9 (9): CD003587. DOI: 10.1002/14651858.CD003587.pub3
  2. Gibbon J.H. Jr. Application of a mechanical heart and lung apparatus to cardiac surgery. Minn. Med. 1954; 37 (3): 171–85.
  3. Шанин Ю.Н. Анестезия при искусственном кровообращении. В кн.: Куприянов П.А. (ред.) Искусственное кровообращение в хирургии сердца и магистральных сосудов. Л.: Ленмедгиз; 1962.
  4. Spencer F.C., Benson D.W., Liu W.C., Bahnson H.T. Use of a mechanical respirator in the management of respiratory or pulmonary disease. J. Thorac. Cardiovasc. Surg. 1959; 38: 758–70.
  5. Dammann J.F. Jr, Thung N., Christlieb L. 2nd, Littlefield J.B., Muller W.H. Jr. The management of the severely ill patient after open-heart surgery. J. Thorac. Cardiovasc. Surg. 1963; 45: 80–90.
  6. Cooperman L.H., Mann P.E. Postoperative respiratory care. A review of 65 consecutive cases of open-heart surgery on the mitral valve. J. Thorac. Cardiovasc. Surg. 1967; 53 (4): 504–7.
  7. Kirklin J.W. Pulmonary dysfunction after open heart surgery. Med. Clin. North Am. 1964; 48: 1063–8. DOI: 10.1016/s0025-7125(16)33436-8
  8. Osborn J.J., Popper R.W., Kerth W.J., Gerbode F. Respiratory insufficiency following open heart surgery. Ann. Surg. 1962; 156 (4): 638–47. DOI: 10.1097/00000658-196210000-00010
  9. Lefemine A.A., Harken D.E. Postoperative care following openheart operations: routine use of controlled ventilation. J. Thorac. Cardiovasc. Surg. 1966; 52 (2): 207–16.
  10. Sykes M.K., Adams A.P., McCormick P.W., Bird B., Greenburgh S. The effect of mechanical ventilation after open-heart surgery. Anaesthesia. 1970; 25 (4): 525–40. DOI: 10.1111/j.1365-2044.1970.tb00259.x
  11. Arens J.F., Benbow B.P., Ochsner J.L., Theard R. Morphine anesthesia for aortocoronary bypass procedures. Anesth. Analg. 1972; 51 (6): 901–9.
  12. Stanley T.H., Webster L.R. Anesthetic requirements and cardiovascular effects of fentanyl-oxygen and fentanyl-diazepam-oxygen anesthesia in man. Anesth. Analg. 1978; 57 (4): 411–6. DOI: 10.1213/00000539-197807000-00008
  13. Klineberg P.L., Geer R.T., Hirsh R.A., Aukburg S.J. Early extubation after coronary artery bypass graft surgery. Crit. Care Med. 1977; 5 (6): 272–4. DOI: 10.1097/00003246-197711000-00004
  14. Barash P.G., Lescovich F., Katz J.D., Talner N.S., Stansel H.C. Jr. Early extubation following pediatric cardiothoracic operation: a viable alternative. Ann. Thorac. Surg. 1980; 29 (3): 228–33. DOI: 10.1016/s0003- 4975(10)61872-3
  15. Lazar H.L., Fitzgerald C.A., Ahmad T., Bao Y., Colton T., Shapira O.M., Shemin R.J. Early discharge after coronary artery bypass graft surgery: are patients really going home earlier? J. Thorac. Cardiovasc. Surg. 2001; 121 (5): 943–50. DOI: 10.1067/mtc.2001.113751
  16. Flynn M., Reddy S., Shepherd W., Holmes C., Armstrong D., Lunn C. et al. Fast-tracking revisited: routine cardiac surgical patients need minimal intensive care. Eur. J. Cardiothorac. Surg. 2004; 25 (1): 116–22. DOI: 10.1016/s1010-7940(03)00608-0
  17. Calafiore A.M., Scipioni G., Teodori G., Di Giammarco G., Di Mauro M., Canosa C. et al. Day 0 intensive care unit discharge – risk or benefit for the patient who undergoes myocardial revascularization? Eur. J. Cardiothorac. Surg. 2002; 21 (3): 377–84. DOI: 10.1016/s1010-7940(01)01151-4
  18. Engoren M., Luther G., Fenn-Buderer N. A comparison of fentanyl, sufentanil, and remifentanil for fasttrack cardiac anesthesia. Anesth. Analg. 2001; 93 (4): 859–64. DOI: 10.1097/00000539-200110000-00011
  19. Möllhoff T., Herregods L., Moerman A., Blake D., MacAdams C., Demeyere R. et al. Remifentanil Study Group. Comparative efficacy and safety of remifentanil and fentanyl in 'fast track' coronary artery bypass graft surgery: a randomized, double-blind study. Br. J. Anaesth. 2001; 87 (5): 718–26. DOI: 10.1093/bja/87.5.718
  20. Cheng D.C., Karski J., Peniston C., Asokumar B., Raveendran G., Carroll J. et al. Morbidity outcome in early versus conventional tracheal extubation after coronary artery bypass grafting: a prospective randomized controlled trial. J. Thorac. Cardiovasc. Surg. 1996; 112 (3): 755–64. DOI: 10.1016/S0022-5223(96)70062-4
  21. Jucá R., Monte L. Early tracheal extubation after coronary artery bypass grafting. J. Thorac. Cardiovasc. Surg. 1997; 114 (4): 687–8. DOI: 10.1016/S0022-5223(97) 70069-2
  22. Sirio C.A., Martich G.D. Who goes to the ICU postoperatively? Chest. 1999; 115 (5): 125S–9S. DOI: 10.1378/chest.115.suppl_2.125s
  23. Ender J., Borger M.A., Scholz M., Funkat A.K., Anwar N., Sommer M. et al. Cardiac surgery fast-track treatment in a postanesthetic care unit: six-month results of the Leipzig fast-track concept. Anesthesiology. 2008; 109 (1): 61–6. DOI: 10.1097/ALN. 0b013e31817881b3
  24. Probst S., Cech C., Haentschel D., Scholz M., Ender J. A specialized post anaesthetic care unit improves fasttrack management in cardiac surgery: a prospective randomized trial. Crit. Care. 2014; 18 (4): 468. DOI: 10.1186/s13054-014-0468-2
  25. Svircevic V., Nierich A.P., Moons K.G., Brandon Bravo Bruinsma G.J., Kalkman C.J., van Dijk D. Fasttrack anesthesia and cardiac surgery: a retrospective cohort study of 7989 patients. Anesth. Analg. 2009; 108 (3): 727–33. DOI: 10.1213/ane.0b013e318193c423
  26. Alhan C., Toraman F., Karabulut E.H., Tarcan S., Daˇgdelen S., Eren N., Caˇglar N. Fast track recovery of high risk coronary bypass surgery patients. Eur. J. Cardiothorac. Surg. 2003; 23 (5): 678–83. DOI: 10.1016/s1010-7940(03)00027-7
  27. van Mastrigt G.A., Heijmans J., Severens J.L., Fransen E.J., Roekaerts P., Voss G., Maessen J.G. Short-stay intensive care after coronary artery bypass surgery: randomized clinical trial on safety and cost-effectiveness. Crit. Care Med. 2006; 34 (1): 65–75. DOI: 10.1097/01.ccm.0000191266.72652.fa
  28. van Mastrigt G.A., Joore M.A., Nieman F.H., Severens J.L., Maessen J.G. Health-related quality of life after fast-track treatment results from a randomized controlled clinical equivalence trial. Qual. Life Res. 2010; 19 (5): 631–42. DOI: 10.1007/s11136-010-9625-5
  29. Constantinides V.A., Tekkis P.P., Fazil A., Kaur K., Leonard R., Platt M. et al. Fast-track failure after cardiac surgery: development of a prediction model. Crit. Care Med. 2006; 34 (12): 2875–82. DOI: 10.1097/01. CCM.0000248724.02907.1B
  30. Lee A., Zhu F., Underwood M.J., Gomersall C.D. Fasttrack failure after cardiac surgery: external model validation and implications to ICU bed utilization. Crit. Care Med. 2013; 41 (5): 1205–13. DOI: 10.1097/CCM. 0b013e31827711ad
  31. Kiessling A.H., Huneke P., Reyher C., Bingold T., Zierer A., Moritz A. Risk factor analysis for fast track protocol failure. J. Cardiothorac. Surg. 2013; 8: 47. DOI: 10.1186/1749-8090-8-47
  32. Chamchad D., Horrow J.C., Nachamchik L., Sutter F.P., Samuels L.E., Trace C.L. et al. The impact of immediate extubation in the operating room after cardiac surgery on intensive care and hospital lengths of stay. J. Cardiothorac. Vasc. Anesth. 2010; 24 (5): 780–4. DOI: 10.1053/j.jvca.2010.04.002
  33. Badhwar V., Esper S., Brooks M., Mulukutla S., Hardison R., Mallios D. et al. Extubating in the operating room after adult cardiac surgery safely improves outcomes and lowers costs. J. Thorac. Cardiovasc. Surg. 2014; 148 (6): 3101–9.e1. DOI: 10.1016/j.jtcvs.2014.07.037
  34. Salah M., Hosny H., Salah M., Saad H. Impact of immediate versus delayed tracheal extubation on length of ICU stay of cardiac surgical patients, a randomized trial. Heart Lung. Vessel. 2015; 7 (4): 311–9.
  35. Borracci R.A., Ochoa G., Ingino C.A., Lebus J.M., Grimaldi S.V., Gambetta M.X. Routine operation theatre extubation after cardiac surgery in the elderly. Interact. Cardiovasc. Thorac. Surg. 2016; 22 (5): 627–32. DOI: 10.1093/icvts/ivv409
****
  1. Wong W.T., Lai V.K., Chee Y.E., Lee A. Fast-track cardiac care for adult cardiac surgical patients. Cochrane Database Syst Rev. 2016; 9 (9): CD003587. DOI: 10.1002/14651858.CD003587.pub3
  2. Gibbon J.H. Jr. Application of a mechanical heart and lung apparatus to cardiac surgery. Minn. Med. 1954; 37 (3): 171–85.
  3. Shanin Yu.N. Anesthesia during cardiopulmonary bypass. In: Kupriyanov P.A. (ed.) Cardiopulmonary bypass in surgery of the heart and magistral vessels. Leningrad: Lenmedgiz; 1962 (in Russ.).
  4. Spencer F.C., Benson D.W., Liu W.C., Bahnson H.T. Use of a mechanical respirator in the management of respiratory or pulmonary disease. J. Thorac. Cardiovasc. Surg. 1959; 38: 758–70.
  5. Dammann J.F. Jr, Thung N., Christlieb L. 2nd, Littlefield J.B., Muller W.H. Jr. The management of the severely ill patient after open-heart surgery. J. Thorac. Cardiovasc. Surg. 1963; 45: 80–90.
  6. Cooperman L.H., Mann P.E. Postoperative respiratory care. A review of 65 consecutive cases of open-heart surgery on the mitral valve. J. Thorac. Cardiovasc. Surg. 1967; 53 (4): 504–7.
  7. Kirklin J.W. Pulmonary dysfunction after open heart surgery. Med. Clin. North Am. 1964; 48: 1063–8. DOI: 10.1016/s0025-7125(16)33436-8
  8. Osborn J.J., Popper R.W., Kerth W.J., Gerbode F. Respiratory insufficiency following open heart surgery. Ann. Surg. 1962; 156 (4): 638–47. DOI: 10.1097/00000658-196210000-00010
  9. Lefemine A.A., Harken D.E. Postoperative care following openheart operations: routine use of controlled ventilation. J. Thorac. Cardiovasc. Surg. 1966; 52 (2): 207–16.
  10. Sykes M.K., Adams A.P., McCormick P.W., Bird B., Greenburgh S. The effect of mechanical ventilation after open-heart surgery. Anaesthesia. 1970; 25 (4): 525–40. DOI: 10.1111/j.1365-2044.1970.tb00259.x
  11. Arens J.F., Benbow B.P., Ochsner J.L., Theard R. Morphine anesthesia for aortocoronary bypass procedures. Anesth. Analg. 1972; 51 (6): 901–9.
  12. Stanley T.H., Webster L.R. Anesthetic requirements and cardiovascular effects of fentanyl-oxygen and fentanyl-diazepam-oxygen anesthesia in man. Anesth. Analg. 1978; 57 (4): 411–6. DOI: 10.1213/00000539-197807000-00008
  13. Klineberg P.L., Geer R.T., Hirsh R.A., Aukburg S.J. Early extubation after coronary artery bypass graft surgery. Crit. Care Med. 1977; 5 (6): 272–4. DOI: 10.1097/00003246-197711000-00004
  14. Barash P.G., Lescovich F., Katz J.D., Talner N.S., Stansel H.C. Jr. Early extubation following pediatric cardiothoracic operation: a viable alternative. Ann. Thorac. Surg. 1980; 29 (3): 228–33. DOI: 10.1016/s0003- 4975(10)61872-3
  15. Lazar H.L., Fitzgerald C.A., Ahmad T., Bao Y., Colton T., Shapira O.M., Shemin R.J. Early discharge after coronary artery bypass graft surgery: are patients really going home earlier? J. Thorac. Cardiovasc. Surg. 2001; 121 (5): 943–50. DOI: 10.1067/mtc.2001.113751
  16. Flynn M., Reddy S., Shepherd W., Holmes C., Armstrong D., Lunn C. et al. Fast-tracking revisited: routine cardiac surgical patients need minimal intensive care. Eur. J. Cardiothorac. Surg. 2004; 25 (1): 116–22. DOI: 10.1016/s1010-7940(03)00608-0
  17. Calafiore A.M., Scipioni G., Teodori G., Di Giammarco G., Di Mauro M., Canosa C. et al. Day 0 intensive care unit discharge – risk or benefit for the patient who undergoes myocardial revascularization? Eur. J. Cardiothorac. Surg. 2002; 21 (3): 377–84. DOI: 10.1016/s1010-7940(01)01151-4
  18. Engoren M., Luther G., Fenn-Buderer N. A comparison of fentanyl, sufentanil, and remifentanil for fasttrack cardiac anesthesia. Anesth. Analg. 2001; 93 (4): 859–64. DOI: 10.1097/00000539-200110000-00011
  19. Möllhoff T., Herregods L., Moerman A., Blake D., MacAdams C., Demeyere R. et al. Remifentanil Study Group. Comparative efficacy and safety of remifentanil and fentanyl in 'fast track' coronary artery bypass graft surgery: a randomized, double-blind study. Br. J. Anaesth. 2001; 87 (5): 718–26. DOI: 10.1093/bja/87.5.718
  20. Cheng D.C., Karski J., Peniston C., Asokumar B., Raveendran G., Carroll J. et al. Morbidity outcome in early versus conventional tracheal extubation after coronary artery bypass grafting: a prospective randomized controlled trial. J. Thorac. Cardiovasc. Surg. 1996; 112 (3): 755–64. DOI: 10.1016/S0022-5223(96)70062-4
  21. Jucá R., Monte L. Early tracheal extubation after coronary artery bypass grafting. J. Thorac. Cardiovasc. Surg. 1997; 114 (4): 687–8. DOI: 10.1016/S0022-5223(97) 70069-2
  22. Sirio C.A., Martich G.D. Who goes to the ICU postoperatively? Chest. 1999; 115 (5): 125S–9S. DOI: 10.1378/chest.115.suppl_2.125s
  23. Ender J., Borger M.A., Scholz M., Funkat A.K., Anwar N., Sommer M. et al. Cardiac surgery fast-track treatment in a postanesthetic care unit: six-month results of the Leipzig fast-track concept. Anesthesiology. 2008; 109 (1): 61–6. DOI: 10.1097/ALN. 0b013e31817881b3
  24. Probst S., Cech C., Haentschel D., Scholz M., Ender J. A specialized post anaesthetic care unit improves fasttrack management in cardiac surgery: a prospective randomized trial. Crit. Care. 2014; 18 (4): 468. DOI: 10.1186/s13054-014-0468-2
  25. Svircevic V., Nierich A.P., Moons K.G., Brandon Bravo Bruinsma G.J., Kalkman C.J., van Dijk D. Fasttrack anesthesia and cardiac surgery: a retrospective cohort study of 7989 patients. Anesth. Analg. 2009; 108 (3): 727–33. DOI: 10.1213/ane.0b013e318193c423
  26. Alhan C., Toraman F., Karabulut E.H., Tarcan S., Daˇgdelen S., Eren N., Caˇglar N. Fast track recovery of high risk coronary bypass surgery patients. Eur. J. Cardiothorac. Surg. 2003; 23 (5): 678–83. DOI: 10.1016/s1010-7940(03)00027-7
  27. van Mastrigt G.A., Heijmans J., Severens J.L., Fransen E.J., Roekaerts P., Voss G., Maessen J.G. Short-stay intensive care after coronary artery bypass surgery: randomized clinical trial on safety and cost-effectiveness. Crit. Care Med. 2006; 34 (1): 65–75. DOI: 10.1097/01.ccm.0000191266.72652.fa
  28. van Mastrigt G.A., Joore M.A., Nieman F.H., Severens J.L., Maessen J.G. Health-related quality of life after fast-track treatment results from a randomized controlled clinical equivalence trial. Qual. Life Res. 2010; 19 (5): 631–42. DOI: 10.1007/s11136-010-9625-5
  29. Constantinides V.A., Tekkis P.P., Fazil A., Kaur K., Leonard R., Platt M. et al. Fast-track failure after cardiac surgery: development of a prediction model. Crit. Care Med. 2006; 34 (12): 2875–82. DOI: 10.1097/01. CCM.0000248724.02907.1B
  30. Lee A., Zhu F., Underwood M.J., Gomersall C.D. Fasttrack failure after cardiac surgery: external model validation and implications to ICU bed utilization. Crit. Care Med. 2013; 41 (5): 1205–13. DOI: 10.1097/CCM. 0b013e31827711ad
  31. Kiessling A.H., Huneke P., Reyher C., Bingold T., Zierer A., Moritz A. Risk factor analysis for fast track protocol failure. J. Cardiothorac. Surg. 2013; 8: 47. DOI: 10.1186/1749-8090-8-47
  32. Chamchad D., Horrow J.C., Nachamchik L., Sutter F.P., Samuels L.E., Trace C.L. et al. The impact of immediate extubation in the operating room after cardiac surgery on intensive care and hospital lengths of stay. J. Cardiothorac. Vasc. Anesth. 2010; 24 (5): 780–4. DOI: 10.1053/j.jvca.2010.04.002
  33. Badhwar V., Esper S., Brooks M., Mulukutla S., Hardison R., Mallios D. et al. Extubating in the operating room after adult cardiac surgery safely improves outcomes and lowers costs. J. Thorac. Cardiovasc. Surg. 2014; 148 (6): 3101–9.e1. DOI: 10.1016/j.jtcvs.2014.07.037
  34. Salah M., Hosny H., Salah M., Saad H. Impact of immediate versus delayed tracheal extubation on length of ICU stay of cardiac surgical patients, a randomized trial. Heart Lung. Vessel. 2015; 7 (4): 311–9.
  35. Borracci R.A., Ochoa G., Ingino C.A., Lebus J.M., Grimaldi S.V., Gambetta M.X. Routine operation theatre extubation after cardiac surgery in the elderly. Interact. Cardiovasc. Thorac. Surg. 2016; 22 (5): 627–32. DOI: 10.1093/icvts/ivv409

About Authors

  • Kakhaber E. Diasamidze, Dr. Med. Sci., Leading Researcher; ORCID
  • Luiza K. Yalieva, Resident Physician; ORCID
  • Georgiy M. Mishin, Postgraduate, Anesthesiologist-Intensivist; ORCID
  • Mariam A. Chitorelidze, Postgraduate, Anesthesiologist-Intensivist; ORCID

 If you found mistakes, select text and press Alt+A