Structure of cardiac surgical intensive care units. Results of a questionnaire in 2008

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.