The Anaesthesia and Intensive Care Unit (A-ICU) at Centro Cardiologico Monzino (CCM) is deeply involved in support of surgical, electrophysiological and interventional activities, as well as in post-operative intensive care.
The A-ICU includes an head of Department, two supervisors, seven senior anaesthetists, four junior anaesthetists and four post-degree trainees in anaesthesia. Most of the staff anaesthetists have been involved in previous clinical or research activities abroad.
The A-ICU personnel is involved in the preoperative assessment of the surgical patients, in intraoperative management and in postoperative intensive care.
Patients are evaluated in the Anaesthesia Clinic, and the surgical indications are discussed with the attending cardiologist and cardiac surgeon (Heart Team).
More than 1,200 cardiac and vascular operations are performed yearly in the hospital’s four operating theatres, and various tailored techniques are used: inhalation, intravenous or loco-regional anaesthesia.
During anaesthesia, all physiological parameters are continuously monitored (cardiac, respiratory, neurological, renal). Transoesophageal echocardiography, including three-dimensional, is extensively used.
Anaesthetists are also daily involved in two electrophysiology operating theatres, where more than 800 procedures of ablation of atrial and ventricular arrhythmias are performed every year, both in deep sedation and under general anaesthesia. They are also involved in approximately 1,500 electrical cardioversions performed under general anaesthesia every year.
Since 2010, the A-ICU is provided with an electronic data collection system (electronic medical record, EMR) both in the Operating Theatres and in the Electrophysiology Theatres and in the Intensive Care ward. This software allows an optimal documentation of clinical data, helps to prevent procedural errors, improves the therapeutic management and enables a higher level of care and data collection for scientific research.
Great importance is given to the control of postoperative pain, which is evaluated with appropriate scales (NRS, CPOT) both before and after drug treatment. Also important is the evaluation of sedation (RASS scale) and delirium (ICDSC scale). Psychological support is available for both patients (especially long-stay patients) and relatives. A questionnaire was recently introduced to assess the relatives’ satisfaction on the quality of care provided: the collected data will be useful to improve the service.
Discharge to the post-ICU surgical ward is based on objective parameters using an internationally validated score scale (NEWS).
A quality control of the service provided is performed every four months, on the base of internationally agreed clinical indicators. Furthermore, the A-ICU anaesthetists acknowledge the emergency calls from other wards and the emergency room. When the necessity of a patient transfer to another hospital arises, the anaesthetists often assist and go with patients in critical conditions.
All A-ICU anaesthetists are involved in training of the specializing doctors from the School of Anaesthesia of the University of Milan; some of them are Contract Professors or Tutors at the same School.
The A-ICU is committed in the updating and clinical training of both medical and nursing staff, also from other units of CCM, by organizing meetings and courses twice a month. Recently treated topics have been the early recognition of sepsis and its treatment, and the good use of blood components and derivatives.
The Intensive Care ward, operational 24/7, takes care of most of surgical patients and of all emergencies, and is staffed with medical personnel specialized in Anaesthesia and Intensive Care. It’s an 11-bed department equipped with the most advanced hemodynamic, respiratory and neurological (NIRS, EEG, CSF pressure) monitoring systems as well as with its own EMR. All diagnostic procedures are available 24/7: conventional radiology, CT scan, angiography, transthoracic and transoesophageal echocardiography, blood gas analysis, bedside coagulation test (ROTEM). Interventional procedures (operating theatres, angiocoronarography, electrophysiology studies) are also available.
Cardiocirculatory failure till cardiogenic shock is dealt with drug therapy, aortic contra-pulsation (IABP), v-aECMO and ventricular-assist devices implantation.
Patients with renal failure (one of the most frequent complication of cardiovascular surgery) are graded according to international criteria (AKIN) and treated with drug therapy and, if necessary, with renal replacement therapy (Hemofiltration, Hemodialysis).
Patients with respiratory failure are treated either with invasive (IPPV, BiPAP, SIMV, CPAP) or non-invasive ventilation (NIV with helmet), with inhalation of nitric oxide (NO), with v-vECMO and if necessary are subjected to diagnostic (bronchoscopy) or therapeutic invasive procedures (percutaneous tracheostomy).
A-ICU doctors are also involved in scientific research activities. The research is very closely linked to the daily clinical activity and the type of patients that are most frequently treated, such as the search for early markers of perioperative renal failure, the study of new pharmacological protocols leading to optimal neurological management, the study of alternative methods of ventilation and the optimization of the heart-lung interaction.
The doctors of the OU are involved in scientific research activities. The research is very closely linked to the daily clinical activity and the type of patients that most frequently come to observation, such as the search for early markers of perioperative renal insufficiency, the study of new pharmacological protocols that allow the maintenance of optimal neurological parameters, the study of alternative methods of ventilation and the optimization of the heart-lung interaction.