When is ICU care warranted after carotid endarterectomy? A three-year retrospective analysis

The purpose was to determine the valid indications for Surgical Intensive Care Unit (SICU) admission after carotid endarterectomy (CEA). The indications for admission to the SICU after CEA were studied over a 3-year period (4/89-3/92). Absolute indications for ICU admission (AIA) included mechanical ventilation, a pulmonary artery catheter, and intravenous vasoactive or antiarrhythmic drug infusion. Patients were grouped according to presence of an AIA (Group A), absence of an AIA and a one day SICU length of stay (Group B), or absence of an AIA and a SICU length of stay > 1 day (Group C). A total of 305 patients were admitted to the SICU during the study. There were 55 patients in Group A. Of the 250 patients without an AIA, 239 were in Group B and 11 comprised Group C. Group A patients had a significantly higher severity of illness compared with Groups B and C (P < 0.05). Group B patients demonstrated no need for SICU care. Group C patients received ongoing SICU care due to postoperative neurological changes, arrhythmias, angina, incisional bleeding, vocal cord paresis, and unavailability of a ward room. None of these conditions was life-threatening and only vocal cord paresis would have required SICU admission. Two patients in Group A died; no patients died in Group B or C. Only patients with an AIA, perioperative neurological changes, or early hemodynamic instability require SICU admission after CEA. An observation period in the recovery room allows for selection of nearly all patients who will eventually require SICU care.