Научно-практический журнал
«Клиническая физиология кровообращения»

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

 

Главный редактор

Лео Антонович Бокерия, доктор медицинских наук, профессор, академик РАН и РАМН, президент ФГБУ «НМИЦ ССХ им. А.Н. Бакулева» МЗ РФ


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

Эволюция стратегии ранней активизации: развитие, формирование, взгляд в будущее. Часть 1

Авторы: Диасамидзе К.Э., Ялиева Л.К., Мишин Г.М., Читорелидзе М.А.

Организация:
ФГБУ «Национальный медицинский исследовательский центр сердечно-сосудистой хирургии им. А.Н. Бакулева» Минздрава России, Москва, Российская Федерация

Для корреспонденции: Сведения доступны для зарегистрированных пользователей.

Раздел: Обзоры

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

УДК: 616-085

Библиографическая ссылка: Клиническая физиология кровообращения. 2022; 3 (19): 211-220

Цитировать как: Диасамидзе К.Э., Ялиева Л.К., Мишин Г.М., Читорелидзе М.А. . Эволюция стратегии ранней активизации: развитие, формирование, взгляд в будущее. Часть 1. Клиническая физиология кровообращения. 2022; 3 (19): 211-220. DOI: 10.24022/1814-6910-2022-19-3-211-220

Ключевые слова: кардиохирургия, ранняя активизация, факторы, препятствующие ранней активизации, экстубация на операционном столе, пожилые пациенты, улучшенное восстановление после операции на сердце

Поступила / Принята к печати:  15.07.2022 / 17.09.2022

Полнотекстовая версия:  

Аннотация

«Fast-track recovery after cardiac surgery» – мультимодальная стратегия, известная в отечественной медицине как ранняя активизация кардиохирургических пациентов. Данный подход обеспечивает максимально возможное сокращение длительности послеоперационной искусственной вентиляции легких (ИВЛ) и проведение экстубации трахеи в течение первых 6 ч после завершения операции на сердце. Ранняя активизация способствует интенсификации лечебного процесса, сокращению длительности пребывания пациентов в отделении реанимации и интенсивной терапии, что в свою очередь приводит к снижению больничных затрат, не сопряженных с ухудшением качества оказываемой медицинской помощи.

В обзоре освещен исторический путь становления и формирования стратегии ранней активизации кардиохирургических пациентов, отражено научное противоречие в вопросах обязательности проведения длительной послеоперационной ИВЛ, а также намечены перспективы дальнейшего развития концепции «fast-track». В статье обобщен международный опыт внедрения стратегии ранней активизации в клинику, приведены данные о результатах влияния длительности послеоперационной ИВЛ на темпы и качество реабилитации кардиохирургических пациентов.

Литература

  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
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  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

Об авторах

  • Диасамидзе Кахабер Энверович, д-р мед. наук, вед. науч. сотр.; ORCID
  • Ялиева Луиза Керимовна, ординатор; ORCID
  • Мишин Георгий Максимович, аспирант, врач – анестезиолог-реаниматолог; ORCID
  • Читорелидзе Мариам Аполлоновна, аспирант, врач – анестезиолог-реаниматолог; ORCID

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