Top Things to Know: Prevention of Complications in the Cardiac Intensive Care Unit
Published: October 29, 2020
Prepared by Paul St. Laurent, DNP, RN, Sr. Science and Medicine Advisor, Lead
- Critically ill cardiac intensive care units (CICUs) patients are susceptible to a multitude of potentially preventable complications associated with increased morbidity, mortality, length of stay, and healthcare expenses.
- There is a need among CICU providers to understand those complications that are most applicable to critically ill cardiovascular (CV) patients, who may not be well represented in the general ICU.
- This scientific statement reviews evidence-based practices derived in non-cardiac ICU populations, assesses their relevance to CICU practice, and highlights key knowledge gaps warranting further investigation to attenuate patient risk.
- Best practices for the prevention of healthcare-associated infection (HAI) and multidrug resistant (MDR) pathogens include meticulous hand hygiene, minimizing the duration of invasive medical appliances, and the use of care bundles.
- Delirium screening, minimizing the use of medications associated with delirium, including benzodiazepines, and implementation of early mobilization protocols may reduce the risk of delirium.
- For patients requiring mechanical ventilation (MV), sedation protocols tailored to the individual patients’ presenting condition, co-morbidities, hemodynamics, and perceived duration of MV can minimize the risk of excess sedation.
- The use of lower tidal volumes for patients at high risk of volume associated lung injury (VALI) or established acute respiratory distress syndrome (ARDS), and tailoring positive end expiratory pressure (PEEP) to each patient’s underlying pathophysiological condition and oxygenation/hemodynamic targets is associated with decreased mortality.
- Early mobilization protocols, which include daily assessment by a multi-disciplinary team, may have a beneficial impact on outcomes such as physical functioning, duration of MV, delirium management, and length of stay.
- Early initiation of enteral nutrition (within 24-48 hours of admission) in patients who are unable to eat is associated with a reduced risk of infection by preserving gut mucosal integrity and preventing bacterial translocation.
- Structured, multidisciplinary rounds – involving physicians from different specialties, nurses, pharmacists, respiratory therapists, physical therapists, and other clinicians – is associated with improved patient outcomes.
Citation
Fordyce CB, Katz JN, Alviar CL, Arslanian-Engoren C, Bohula EA, Geller BJ, Hollenberg SM, Jentzer JC, Sims DB, Washam JB, van Diepen S; on behalf of the American Heart Association Council on Clinical Cardiology; Council on Arteriosclerosis, Thrombosis and Vascular Biology; Council on Cardiovascular and Stroke Nursing; Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation; and Stroke Council. Prevention of complications in the cardiac intensive care unit: a scientific statement from the American Heart Association [published online ahead of print October 29, 2020]. Circulation. doi: 10.1161/CIR.0000000000000909.