Annex A > Chapter 3 - Developments in the UK, in the Diagnosis and Treatment of Congenital Heart Abnormalities in Children, 1984-1995 > Post-operative care

Post-operative care

29 There have been significant changes in intensive care, most notably an improved understanding of cardiovascular physiology in neonates and infants, which has contributed to the significant improvement in mortality rates amongst these babies. In the early years covered by the Inquiry it would have been the practice in the majority of units for surgeons to take primary responsibility for post-operative care while anaesthetists were chiefly involved in managing the child's ventilatory support. From the early 1990s onwards, some centres started to involve anaesthetists more fully in the management of the care of children in intensive care, with anaesthetists taking on clinical sessions dedicated to the ICU. In some units this had, by 1995, evolved to the point where a full-time intensivist (usually an anaesthetist) had been appointed to the ICU.

30 From the early days of cardiac surgery it has normally been the practice for all members of the multidisciplinary team to be fully involved in the management of the child in the ICU, all providing their particular skills. During the early 1980s these arrangements tended to become more formalised in most of the major centres. Commonly at least one ward round would occur every day, attended by the cardiac surgeon, cardiologist and anaesthetist or intensivist, and often by other members of the multidisciplinary team. Decisions were made as a result of discussion on those ward rounds. Examples of such decisions include the need for the cardiologist to perform an echocardiogram, for the surgeon to insert a chest drain, for the anaesthetist or intensivist to change the ventilator settings or for changes to be made in intravenous therapy.

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