Safety and complications of percutaneous tracheostomy in a cohort of 800 mixed ICU patients

Percutaneous tracheostomy is used primarily to assist weaning from mechanical ventilation in the intensive care unit. We report our experiences of 800 such procedures performed in the intensive care unit by a collaborative team (critical care and ENT specialists). Most procedures (85.6%) were performed by residents supervised by the intensive care unit staff. Complications occurred in 32 patients (4%). Intraprocedural complications occurred in 17 patients (2.1%), early postprocedural complications in six (0.75%), and late postprocedural complications in nine (1.1%). No deaths were directly related to percutaneous tracheostomy. The incidence of complications was greater in percutaneous tracheostomy performed by the residents during their initial five attempts compared to their later attempts (9.2% vs 2.6%, p < 0.05). The low incidence of complications indicates that bedside percutaneous tracheostomy can be performed safely as a routine procedure in daily care of intensive care unit patients.     

Reoperation in the intensive care unit

From July 1, 1984, through June 30, 1989, after 1,259 open heart operations, 110 patients (8.7%) underwent 162 early reoperations either in the intensive care unit (144 procedures) or in the operating room (26 procedures). Reexploration for bleeding (49 procedures) (3.9%) and intraaortic balloon removal (50 procedures) (4.0%) were the two most common procedures. Ninety percent and 96% of these procedures, respectively, were performed in the intensive care unit. Mediastinal infections occurred in 4 (6.1%) of 66 patients undergoing repeat mediastinal operations for all indications. No infection occurred after reexploration for bleeding nor did mediastinal infection occur after reoperation in the intensive care unit. Postoperative death in these 110 patients was not related to reoperation except possibly in the case of 1 patient (0.9%). Average transit time to and from the operating room for patients returned there for reoperation was 89.7 minutes. Charges for procedures performed in the operating room were at least twice as great as for those performed in the intensive care unit. This experience supports expanded use of reoperation in the intensive care unit, as it is safe, effective, economical, and convenient.     

Universal precautions are not universally followed.

Adherence to universal blood and body fluid precautions was studied in surgical patient care areas of a university hospital in an effort to identify potentially hazardous health care personnel practices. Surgical teams of an 18-unit operating room, three surgical ward patient care teams, and patient care personnel in a 16-bed surgical intensive care unit were observed during routine patient care activities before (study 1) and after (study 2) specific educational programs were held to improve universal precaution compliance. Overall, infractions occurred in 57% of 549 observed procedures in study 1 and in 58% of 616 observed procedures in study 2. In study 1, infractions occurred in 75% of operating room procedures, 30% of surgical ward procedures, and 75% of surgical intensive care unit procedures. Study 2 procedure infraction rates were 81%, 32%, and 40%, respectively. Only surgical intensive care unit compliance significantly improved. Noncompliance with universal precautions occurs frequently during the care of patients who have undergone surgery, with the type of infraction and specific offender varying according to patient locale. These violations appear unamenable to one-time educational efforts. Substantial overall improvement may arise from ongoing educational programs directed at specific personnel who care for patients who have undergone surgery.     

Is routine ultrasound guidance for central line placement beneficial? A prospective analysis

OBJECTIVE: Portable ultrasound devices have become more readily available in the intensive care unit setting, but their utility outside of controlled trials remains unproven. We sought to determine how the availability of ultrasound guidance affected the types and number of complications during central line placement. DESIGN: Review of a prospectively maintained database in a 20-bed combined intensive care unit. Procedure notes from all attempts at internal jugular vein access from 1996 to 2001 were recorded, and selected patient records were reviewed. Ultrasound guidance was available beginning in March 1998. RESULTS: From 1996 to 2001, there were 484 documented attempts at internal jugular central line placement. Most procedures (83%) were performed by first- or second-year residents. During this period, there were 47 complications for an overall complication rate of 10%. These included 1 pneumothorax (2%), 6 carotid punctures (13%), 2 hematomas (4%), and 34 unsuccessful attempts (72%). There was no significant difference in age, sex, body-mass index, or intubation status between those with and without complications or between the ultrasound and anatomic landmark groups. Ultrasound was used in 179 (37%) attempts. The overall complication rate with ultrasound was 11% versus 9% using anatomic landmarks (p = NS). The complication rate prior to the availability of ultrasound was 15 of 114 attempts (13%) versus 32 of 370 attempts (9%) after the introduction of ultrasound in our intensive care unit (p = NS). Analysis of the 370 procedures performed since ultrasound became available demonstrated a complication rate of 11% with ultrasound guidance versus 6% without (p = 0.09). There was no significant difference in complication rates by resident year group or department (surgery vs. other). However, procedures performed after-hours (1800 to 0800) were associated with a 15% complication rate versus 6% for procedures performed during the workday (p < 0.05). CONCLUSION: The availability and use of ultrasound guidance for central line placement by junior residents has not resulted in an improvement in procedure-related complications. The complication profile was not affected by ultrasound use, patient factors, or resident year in training. There was a higher complication rate associated with procedures performed at night that may be caused by resident fatigue or unavailability of senior supervision.     

Carotid endarterectomy: a safe cost-efficient approach.

The diagnosis-related groups have encouraged physicians to become more efficient in the care of their patients; often, however, raising the question of safety. For 3 years all patients undergoing carotid endarterectomy at our institution were monitored in the intensive care unit for 24 hours and the majority were discharged on the second postoperative day. After review of these patient's hospital records and direct patient interviews, it was clear that many patients did not require a stay in the intensive care unit and could be discharged on the first postoperative day. In January 1991 a prospective policy was established to evaluate the safety and efficacy of outpatient arteriography, same-day admission, selective use of the intensive care unit, and early discharge on the first postoperative day when feasible. During a 10-month period all patients undergoing carotid endarterectomy at our institution were evaluated (n = 52). Eleven patients had had a prior stroke (21%), 31 had either amaurosis fugax or transient ischemic attacks (60%), and 10 had no symptoms (19%). The arteriogram for 49 of the patients was obtained on an outpatient basis or during a prior admission, and these patients were admitted to the hospital on the day of operation. Nine patients were placed under general anesthesia and had shunting procedures, and 43 patients had cervical block anesthesia, eight of whom had shunting (19%). Only five patients required an intensive care unit stay for either hypertension, hypotension, or neurologic complication (one transient ischemic attack and one minor stroke). Forty-six patients (88%) were discharged on the first postoperative day; average length of stay was 1.29 days/patient.(ABSTRACT TRUNCATED AT 250 WORDS)     

Acute poststernotomy mediastinitis managed with debridement and closed-drainage aspiration: factors associated with death in the intensive care unit

OBJECTIVE: The purpose of the study is to describe an intensive care unit's experience in the treatment of poststernotomy mediastinitis and to identify factors associated with intensive care unit death. METHODS: Over a 10-year period, 316 consecutive patients with mediastinitis occurring less than 30 days after sternotomy were treated in a single unit. First-line therapy was closed-drainage aspiration with Redon catheters. Variables recorded, including patient demographics, underlying disease classification, clinical and biologic data available at intensive care unit admission and day 3, and their association with intensive care unit mortality, were subjected to multivariate analyses. RESULTS: Intensive care unit mortality (20.3%) was significantly associated with 5 variables available at admission: age greater than 70 years (odds ratio, 2.70), operation other than coronary artery bypass grafting alone (odds ratio, 2.59), McCabe class 2/3 (odds ratio, 2.47), APACHE II score (odds ratio, 1.12 per point), and organ failure (odds ratio, 2.07). After introducing day 3 variables into the logistic regression model, independent risk factors for intensive care unit death were as follows: age greater than 70 years, operations other than coronary artery bypass grafting alone, McCabe class 2/3, APACHE II score, mechanical ventilation still required on day 3, and persistently positive bacteremia. For patients receiving mechanical ventilation for less than 3 days, mortality was very low (2.4%). In contrast, for patients receiving mechanical ventilation for 3 days or longer, mortality reached 52.8% and was associated with non-coronary artery bypass grafting cardiac surgery, persistently positive bacteremia, and underlying disease. CONCLUSIONS: In patients requiring intensive care for acute poststernotomy mediastinitis, age, type of cardiac surgery, underlying disease, and severity of illness at the time of intensive care unit admission were associated with intensive care unit death. Two additional factors (mechanical ventilation dependence and persistently positive bacteremia) were identified when the analyses were repeated with inclusion of day 3 patient characteristics.     

Experience with procedural sedation in a pediatric burn center.

BACKGROUND: Burn care requires daily debridement, dressing changes, and assessment regarding the need for skin grafting. These procedures are painful and may require an operating room environment. METHODS: The authors reviewed their experience with 912 consecutive procedural sedations (PS) in 220 pediatric burn patients over a 2-year period to identify what influence PS had on patient care. Median patient age was 32 months, and body surface area burn was 7.2%+/-6%. Pharmacological techniques included oral and intravenous medications and N2O. The authors included all sedations given in the burn treatment area and excluded all treatments given in the intensive care unit or emergency unit. RESULTS: PS allowed for early aggressive wound debridement, virtually eliminated the need for operating room debridement (used in only 22 patients), and eliminated patient discomfort and fear often associated with subsequent debridements. Burn wound-related complications occurred in 54 patients and included wound infection (n = 18), graft loss (n = 9), and pneumonia (n = 4). The incidence of PS complications was 7% with the most common problems including decreased arterial saturation (n = 41), emesis (n = 11), and agitation (n = 8). No patient required intubation or transfer to an intensive care unit bed. The average length of stay (LOS) for all patients was 8.7+/-6.2 days, and 6.2+/-3.8 days in the 200 patients not admitted to the intensive care unit. This compares favorably with the 9.5-day LOS of patients treated in 1990. CONCLUSIONS: PS in burn patients allows for early aggressive debridement, decreases the use of the operating room for debridement, and a decrease in length of stay when compared with our previous burn patients. PS has a modest risk of complications, enhances the family's cooperation and satisfaction with health care provided, and should be an integral part of burn care in children.     

Cardiac reoperation in the intensive care unit

Background. At our institution, cardiac reoperations are routinely performed in the cardiac intensive care unit, as opposed to taking these patients back to the operating room. Our hypothesis was that reoperation in a cardiac intensive care unit does not increase sternal infection rate.

Methods. A retrospective analysis was performed on 6,908 adult patients undergoing cardiac operation over a 9-year period. Excluding those in cardiac arrest, 340 (4.9%) patients underwent reoperation in the cardiac intensive care unit, of which 289 survived (85%).

Results. Of the 289 patients who survived reoperation in the intensive care unit, 6 developed wound infections that required operative debridement (2.1%), which was not significantly different from those patients not requiring reoperation (1.9%, 121 of 6,497, p = 0.70). Hospital charges for a 2-hour reoperation in the intensive care unit and operating room are approximately $1,972/patient and $5,832/patient, respectively.

Conclusions. Reoperation in the intensive care unit does not increase wound infection rate compared to those without reoperation. Decreased charges, avoiding transport of potentially unstable patients, quicker time to intervention, and convenience are advantages of reoperation in an intensive care unit.     

Early tracheostomy for primary airway management in the surgical critical care setting

During a 12-month period, 264 patients with multiple injuries who required mechanical ventilation were admitted to the surgical intensive care unit. One hundred twenty patients (46%) were disengaged from the ventilator, and 38 patients (14%) died. Of the remaining 106 patients (40%) 51 patients (group I) were to receive tracheostomy within 1 to 7 days, and 55 patients (group II) underwent late (8 or more days after admission) tracheostomy. Multiple variables in four categories (admission, operative, ventilatory, and outcome) were analyzed prospectively to define the impact that early tracheostomy had on duration of mechanical ventilation, intensive care stay, and hospital stay. Morbidity and mortality rates of the procedures were assessed. Early tracheostomy, in a homogeneous group of critically ill patients, is associated with a significant decrease in duration of mechanical ventilation, as well as shorter intensive care unit and hospital stays, compared with translaryngeal endotracheal intubation. There were no deaths attributable to tracheostomy, and overall morbidity of the procedures was 4%. We conclude that early tracheostomy has an overall risk equivalent to that of endotracheal intubation. Furthermore, early tracheostomy shortens days on the ventilator and intensive care unit and hospital days and should be considered for patients in the intensive care unit at risk for more than 7 days of intubation.     

The lateral limited thoracotomy incision: standard for pulmonary operations

Four hundred sixty-eight consecutive thoracotomies for which the lateral limited thoracotomy incision was used are reviewed (1978 to 1988). The limited incision is a lateral muscle-splitting incision with preservation of the latissimus dorsi, splitting of the serratus anterior, and cutting of only the intercostal muscles without rib resection. Patients were designated unsuitable for operation if (1) biopsy-proved distant metastasis existed, (2) mediastinoscopy revealed extranodal metastasis, or (3) severe respiratory compromise resulted in shortness of breath at rest with a forced expiratory volume in 1 second of less than 0.75 L (four patients). Mean patient age was 60.9 (+/- 15.7) years. Surgical procedures included lobectomy (n = 317), pneumonectomy (n = 41), wedge resection (n = 82), resections of blebs or bullae (n = 17), thoracotomy and biopsy for unresectable lesion (n = 6), and decortication (n = 5). Pathologic analysis revealed 354 malignant tumors, 102 benign lesions, and 12 carcinoids. The perioperative mortality rate was 0.85% (4/468) and major morbidity was present in 2.9% (14/468). Mean operative time was 73.1 (+/- 32.2) minutes with a blood loss resulting in a mean decrease of the hematocrit value of 2.6 (+/- 2.5) gm; three patients were given a total of 7 units of blood. Most patients do not require a stay in the intensive care unit postoperatively (less than 10%). Hospital stay postoperatively was a mean of 6.1 (+/- 2.9 days. The limited incision is a significant factor in decreasing operative time, blood loss, postoperative pain and morbidity, and cost.     

Assessment of ventricular function in critically ill patients: limitations of pulmonary artery catheterization. Institutions of the McSPI Research Group.

OBJECTIVE: To determine the accuracy of conventional hemodynamic assessment using pulmonary artery catheter-derived data in critically ill patients. DESIGN: Cohort study. SETTING: Kaiser Permanente and Veterans Affairs Medical Centers. PARTICIPANTS: Twenty-five consecutive patients who had undergone elective aortocoronary bypass surgery. MEASUREMENTS AND MAIN RESULTS: In the intensive care unit, conventional assessment (CA) was performed hourly by clinicians using conventional (radial artery and pulmonary artery) hemodynamic measurements from which left ventricular (LV) function and intracardiac volume were estimated. Simultaneously, transesophageal echocardiography (TEE) data were recorded on videotape, blinded to the clinicians, and quantitatively analyzed off-line. TEE-determined LV function was classified as either normal (ejection fraction > or =40%) or abnormal (ejection fraction <40%) and intracardiac volume as normal (end-diastolic area = 8 to 22 cm2), low (end-diastolic area <8 cm2), or high (end-diastolic area >22 cm2). CONCLUSION: Evaluable data included 130 of 150 (87%) observations of simultaneously collected CA and TEE data, averaging 5.6+/-4.4 observations per patient. The overall predictive probability for conventional clinical assessment of normal ventricular function was 98% (118/121), whereas for abnormal ventricular function it was 0% (0/9). For CA of volume, the overall predictive probabilities for hypovolemia, normovolemia, and hypervolemia were 50% (3/6), 60% (69/115), and 22% (2/9). Although conventional clinical assessment of normal LV function in the intensive care unit correlates well with echocardiographic assessment, both LV dysfunction and extremes of preload (hypovolemia or hypervolemia) are assessed poorly by clinicians using conventional clinical monitoring with pulmonary artery catheterization.     

Need for maternal critical care in obstetrics: a population-based analysis

The purpose of this study was to note potential obstetric risk factors leading to maternal intensive care and to estimate the frequency, costs and outcomes of management. In a cross-sectional study of intensive care admissions in Kuopio from March 1993 to October 2000, 22 consecutive obstetric patients admitted to a mixed medical-surgical intensive care unit were followed. We recorded demographics, admitting diagnoses, APACHE II score, clinical outcomes and treatment costs. The overall need for maternal intensive care was 0.9 per 1000 deliveries during the study period. The mean age (+/-SD) of the patients was 31.7 (+/-6.6) years and the APACHE II score 10.8 (+/-6.2). The most common admission diagnoses were obstetric haemorrhage (73%) and pre-eclampsia-related complications (32%). The duration of ICU stay was 5.8 days (range 1-31) and one of the 21 patients died in the intensive care unit (4.5%). The total cost of intensive care was in the order of USD 5000 per patient. Very few obstetric patients develop complications requiring intensive care. Although several risk factors associated with maternal intensive care were documented, most cases occurred in low-risk women, which implies that the risk is relevant to all pregnancies. Long-term morbidity was rare, and collectively the outcome of intensive care was good. Further research is needed to determine effective approaches in prevention, such as uterine artery embolization.     

Comparison of Outcomes following Transhiatal or Ivor Lewis Esophagectomy for Esophageal Carcinoma

p = 0.05); if two surgeons operated concurrently, THO could be performed 40 minutes quicker than THO or ILO performed by a single surgeon (p= 0.018). The mean initial intensive care unit stay was 2.9 days for ILO versus 1.7 days for THO (p= 0.014). The 30-day mortality was 5.1%; total in-hospital mortality was 7.1% with no difference for operation type. There were similar morbidity rates for the procedures. Kaplan-Meier survival analysis indicated no significant effect of surgical technique; there were no apparent advantages for either operation when patients were compared by tumor type or matched for stage. Hence THO is a valid alternative to ILO, particularly for stage II and III cancer.     

Severe maternal morbidity in a general intensive care unit in Nigeria: clinical profiles and outcomes

BackgroundData on outcomes of obstetric admissions to intensive care units can serve as useful markers for assessing the quality of maternal care. We evaluated the intensive care unit utilization rate, diagnoses, case-fatality rate, mortality rate and associated factors among obstetric patients.MethodsA prospective observational study of obstetric patients admitted to the general intensive care unit was performed. Women at 24 or more weeks of gestation, or within six weeks postpartum, who were admitted to the intensive care unit constituted the study population.ResultsA total of 101 obstetric patients were admitted to the intensive care unit. Obstetric patients accounted for approximately 12% of all intensive care unit admissions. Over 90% of admissions were from direct obstetric morbidity such as hypertensive disorders (41.6%), major obstetric haemorrhage (37.6%) and sepsis (11.9%). Forty-three women (42.6%) died, giving an overall mortality rate of 1 in 2.4. Sepsis had the highest case-fatality rate (1 in 1.7) followed by obstetric haemorrhage (1 in 2.1) and hypertensive disorders (1 in 3.6). In univariable logistic regression analysis, abdominal delivery and/or peripartum hysterectomy, had 2.7-fold (95% CI 1.1 to 6.5) increased risk of maternal death as compared to vaginal delivery.ConclusionDirect obstetric morbidities constituted the leading reasons for obstetric admissions to the intensive care unit, with sepsis accounting for the highest case-fatality rate. Abdominal delivery and/or peripartum hysterectomy increased risk of death among obstetric admissions.     

An audit of intrathecal morphine analgesia for non-obstetric postsurgical patients in an adult tertiary hospital

We conducted a retrospective audit of adult non-obstetric patients who had received a single dose of intrathecal morphine for postoperative analgesia. These patients were predominantly admitted to a regular postsurgical ward with strict hourly nursing observations, treatment protocols in place and supervision by an Acute Pain Service for the first 24 hours after intrathecal morphine administration. A total of 409 cases were examined for sedation score, incidence of respiratory depression and other side-effects, admission to the high dependency or intensive care unit and opioid-tolerance. Respiratory depression was defined as requiring treatment with naloxone (implying a sedation score of 3 irrespective of respiratory rate), or a sedation score of 2 with a respiratory rate less than six breaths per minute. The patients were predominantly elderly (57.2% were over the age of 70 years) and 84.8% had undergone vascular surgery. Of the total of 409 cases, only one case of respiratory depression was observed. A total of 77 patients were admitted to high dependency or intensive care unit for various reasons including management of postsurgical complications and patient co-morbidities. Our findings suggest that elderly patients who receive intrathecal morphine analgesia can be safely managed in a regular postsurgical ward.     

Outcomes of hemodialysis-dependent patients following elective abdominal aortic aneurysm repair

As hemodialysis-dependent patients have a shorter life expectancy it has been recently questioned whether they benefit from procedures such as abdominal aortic aneurysm (AAA) repair. The purpose of this study was to review our results with elective AAA repair in hemodialysis-dependent patients. During a recent 6-year period (1998-2003), 7 such patients underwent elective repair of their infrarenal aortic aneurysms. Mean age and aneurysm diameter were 71 years and 69 mm, respectively. Mean length of stay was 28.6 days including routine intensive care unit admission. Three patients underwent standard open repair, and 3 underwent endovascular repair. In the seventh patient iliac calcification precluded endograft delivery and resulted in conversion to open repair. Another endovascular patient suffered from perforation of her sigmoid colon. One- and 3-year survival rates in the entire cohort were 100% and 75%, respectively. The authors conclude that aneurysm repair in hemodialysis patients is warranted and life prolonging in appropriate risk patients, despite lengthy hospital stays. However, successful endovascular repair may be prevented by the severe arterial calcification in these patients.     

Children in Sweden admitted to intensive care after trauma

OBJECTIVE: The aims of this study were to describe the demographics, injuries, mechanisms and severity of injury, prehospital and hospital care during the first 24h, and patient outcome, in the most severely injured children cared for following trauma at a paediatric intensive care unit in Sweden. METHODS: The medical records of 131 traumatised children (0-16 years of age), admitted to the paediatric intensive care unit in Gothenburg from January 1990 to October 2000, were retrospectively examined. Nine internationally recognised scoring systems were used to calculate severity of injury, in order to predict the chances of patient survival. RESULTS: Paediatric trauma was more common in boys (68%). The mean age at injury was 7.9 years (S.D. 4.7 years). Traffic-related accidents (40%) and falls (34%) were the leading causes of injury. Injuries to the head were the most frequent, forming 24% of all injuries. Severity of injury was recorded as an Injury Severity Score median of 14, Trauma Score Injury Severity Score median of 99% and Paediatric Risk of Mortality Score median of 0.69%. The mortality rate was 3%. CONCLUSION: Trauma with admission to a paediatric intensive care unit is rare in a Swedish paediatric population. When cared for at a centre with the necessary facilities and trained personnel, these children have a good chance of survival.     

Factors influencing intensive care unit length of stay after surgery for acute aortic dissection type A

BACKGROUND: Operative mortality after acute aortic dissection type A is still high, and prolonged stay at the intensive care unit is common. Little has been documented about factors influencing the intensive care unit length of stay. The aim of this study was to determine such variables. METHODS: During a 10-year period, 67 patients (47 male, 20 female) were operated on for acute aortic dissection type A. In 42 patients (63%), an ascending aortic replacement was performed, 23 patients (34%) underwent a Bentall procedure, and 2 patients (3%) received a valve-sparing David type of operation. In 14 of these cases (20%), an additional partial or total arch replacement was performed. RESULTS: Hospital mortality was 9 of 67 (14%). Median postoperative intensive care unit length of stay was 5 days (range, 1 to 72 days). Intensive care unit stay was in univariate analysis significantly influenced by the following factors: age (p = 0.008), body mass index (p = 0.039), cardiopulmonary bypass time (p = 0.018), aortic cross-clamp time (p = 0.031), postoperative low cardiac output syndrome (p < 0.001), and postoperative lactate levels (p = 0.01). By multivariate analysis, age (p = 0.012), cardiopulmonary bypass time (p = 0.037), and the presence of a postoperative low cardiac output syndrome (p < 0.001) significantly influenced intensive care unit stay. CONCLUSIONS: Stay in the intensive care unit after operation for acute aortic dissection type A seems to be determined by age, cardiopulmonary bypass time, and the postoperative presence of a low cardiac output syndrome.     

Struktur herzchirurgischer Intensivstationen

In spring 2008, a standardized questionnaire was sent to the heads of all German cardiac surgical centers to gain information about structural characteristics of cardiac surgical intensive care units. We received answers from 65 institutions (81% of the units performing cardiac surgery in Germany) Compared to the previous questionnaires from 1998 and 2003, the number of intensive care beds increased to a median of 15. The rate of intensive care units exclusively for patients after cardiac surgery showed a constant decrease to 68% (1998: 77%, 2003: 73%). Cardiac surgeons served as medical leader for the intensive care unit in 57% (1998: 59%, 2003: 51%), in 11% the unit was run by cardiac surgeons in collaboration with a colleague of other speciality. As in previous years, the majority of the physicians’ teams was interdisciplinary (61%), i.e. cardiac surgeons and others, usually anesthesiologists. Roughly half of the cardiac surgical leaders on intensive care units were board-certified intensivists (51%). This rate increases to 78% looking at intensive care units run exclusively by cardiac surgeons additionally representing a substantial improvement compared to 57% in 2003. Total number of physicians and nurses working on the intensive care unit showed nearly no change compared to previous years and are still below the standards set by the German Interdisciplinary Association of Critical Care Medicine, a finding commonly seen on all intensive care units in Germany. A satisfactory 39% of the physicians and 44% of the nurses were certified intensivists, and intensive care nurses, resp. In summary, there is no other surgical discipline that owns, leads and runs so many intensive care units and beds in relation to the number of regular wards and beds. The increasing number of intensive care beds compared to previous years’ data represents the adequate reaction to the increasing demand caused by demographic patient characteristics with increasing complexity of co-morbidities among patients undergoing cardiac surgery. The number of physicians and nurses, however, is still below the expectations of medical experts. The scientific and practical competence for performing high quality intensive care appears to be satisfactory if focussed to the rate of board-certified physicians and nurses. In contrast, the number of cardiac surgical intensive care units providing an intensive care training program could be somewhat higher than the actual 72%, a rate which decreased during the past 5 years by 11%. In summary, the results corroborate that intensive care represents a substantial part for the clinical pathway of patients undergoing heart surgery. However, further efforts are necessary to keep this attitude alive for the future.