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J Thorac Cardiovasc Surg 2007;134:1109-1111
© 2007 The American Association for Thoracic Surgery

Editorial

The emerging specialty of cardiothoracic surgical critical care: The leadership role of cardiothoracic surgeons on the multidisciplinary team

George Washington University, the Washington Institute of Thoracic and Cardiovascular Surgery, and the Foundation for the Advancement of Cardiothoracic Surgical Care, Washington, DC.

Received for publication April 30, 2007; revisions received June 13, 2007; accepted for publication July 5, 2007.

^_* Address for reprints: Nevin M. Katz, MD, 2175 K Street, NW, Suite 300, Washington, DC 20037. (Email: nevinkatz@aol.com).

The first 300 words of the full text of this article appear below.

It is apparent that the increasing complexity of cardiothoracic surgical (CTS) cases requires a new level of critical care performance. Although the cardiothoracic (CT) surgeon has traditionally provided this care with the assistance of residents and fellows, the organization of critical care is changing. A new system of multidisciplinary CTS critical care is emerging, for reasons described below. I believe that the CT surgeon is uniquely positioned to have a leadership role on the multidisciplinary team and to coordinate this new system of care.

With the changes in house staff working hours and the corresponding decreasing role of surgical residents and fellows in the care of CTS patients, physician assistants and nurse practitioners are having a greater role in minute-to-minute clinical decision making and protocol development. It is important that this valuable participation of paramedical personnel be properly integrated into CTS critical care programs. The surgeon is uniquely qualified to coordinate and to assist in the training and certification of paramedical personnel as they assume this expanded role in the critical care of CTS patients.

The situation, however, is more complicated in several regards. The relative roles of CT surgeons and intensivists in the CTS critical care unit have become unclear. Safety remains an issue in health care and includes the field of critical care. New protocols have been instituted to address safety issues in the intensive care unit.¹ A variety of studies in the critical care literature have led to new concepts of management with improvements in mortality and morbidity. Examples include the treatment of sepsis,² the management of patients with ventilator-associated pneumonia,³ and the use of lung-protective ventilation strategies in acute lung injury.⁴ Some concepts such as the importance of tight glucose control in the critical care patient have appeared in the CT literature as well.⁵ It is . . . [Full Text of this Article]