Introduction

Cardiothoracic critical care has developed to provide a service to patients in the perioperative period of a cardiothoracic surgical episode. It is therefore natural this has been predominantly led by the surgeons and anaesthetists managing the patients in the operating room.

Traditionally, the cardiothoracic surgical patient has been cared for by an informal system in which the responsible surgeon cooperates to a greater or lesser degree with the anaesthetic team in the critical care area. This model is now changing as patients are older and sicker and as cardiothoracic critical care achieves increasing recognition as a specialist areas of practice. Quite commonly, initial management is carried out by the cardiothoracic surgical team, with patients formally transferred to the critical care team after 24 to 48 hours.

Level of care

Increasingly, there is a perceived divide between relatively low-risk patients having surgery and higher risk patients with an anticipated high level of postoperative dependency. Different care pathways are appropriate for these groups of patients, always accepting that the occasional patient in the lower risk group will require prolonged intensive care.

This may mean that the critical care unit can be divided into separate areas with different staffing levels, depending on the patient population. Alternatively, the low-risk patients could be admitted to a different unit altogether, as is the custom in a number of centres.