[Quality standards in intensive care of cardiac surgery]. / Qualitätsstandards in der herzchirurgischen Intensivmedizin.

The quality of ICU treatment is very important with regard to the outcome of patients requiring prolonged ICU stay following cardiac surgery. We conducted an internal quality survey and observed a one-year survival rate of almost 75 % after protracted ICU stay. In order to optimize the quality we identified pulmonary hypertension and prolonged mechanical ventilation as predictors for an adverse outcome. According to our findings the risk for a prolonged postoperative course is higher in patients with impaired renal function and in patients undergoing complex procedures. In these patients preoperative right heart catheterization should be performed without exception. If treatment of high pulmonary resistance leads to a benefit in terms of survival should be a matter of future investigations. There are several causes which may lead to prolonged mechanical ventilation and most of them can hardly be affected. It is known that the application of CPB impairs the respiratory function. Own studies demonstrated that the utilization of a minimized CPB does not lead to shorter ventilation times. Since there is no promising approach to reduce ventilation time by standardized means, early extubation remains the main measure. It is a long and stony way to implement quality standards on the basis of quality surveys. Finding an effective approach to optimize quality is often difficult. However, discouragement has to be avoided at al costs, since the continuous endeavor after quality and improvement of quality are basic requirements of medical progress.