Description

Thomson et al listed criteria for when a patient is ready to be discharged from the intensive care unit (ICU) following cardiac surgery. A patient who meets criteria at discharge is less likely to require readmission to the ICU. The authors are from St. George's Hospital in London.


Patient selection: cardiac surgery

 

Respiratory parameters:

(1) able to maintain a patent airway without the need for advanced respiratory support

(2) adequate oxygenation with PaO2 > 9 kPa and percutaneous oxygen saturation > 94% on FIO2 < 0.5

(3) achieve adequate ventilation (with PaCO2 < 6 kPa for patient without COPD)

(4) respiratory rate < 20 breaths per minute

 

Cardiovascular parameters:

(1) normal sinus rhythm or preoperative rhythm (includes atrial fibrillation if adequate rate control)

(2) heart rate 60-100 beats per minute

(3) hemodynamically stable

(4) not receiving inotropes or vasopressors

(5) serum lactate < 2 mmol/L

(6) chest drain < 50 mL/h without ongoing blood loss

(7) hemoglobin > 80 g/L

 

Other parameters:

(1) urine output > 0.5 mL per kg per hour

(2) adequate analgesia without IV morphine

(3) alert and oriented if possible, else preoperative neurological status

(4) able to tolerate oral intake of fluids

(5) normal body temperature (< 37.5°C)

 

where:

Some exceptions can be made if the patient is going to a step-down unit or specialized care unit or if the patient is being monitored.


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