AHA releases guidance for Best Practices in Cardiac ICU
Contemporary cardiac intensive care units (CICUs) have an increasing prevalence of noncardiovascular comorbidities and multisystem organ dysfunction. However, little guidance exists to support the development of best-practice principles specific to the CICU.
American Heart Association Scientific has released new Statement, "Prevention of Complications in the Cardiac Intensive Care Unit," that has been published in the Association's flagship journal Circulation. The Statement reviews evidence from general medical and surgical ICUs to identify opportunities to apply them to the care of critically ill heart patients and improve CICU outcomes.
Critically ill heart patients are at increased risk of complications that are potentially preventable and associated with death, longer hospital stays and higher costs.Best practices to prevent complications include meticulous hand hygiene among the health care team, prompt removal of invasive medical devices and implementing a multidisciplinary team of health care professionals from various specialties.The statement suggests a bedside checklist to monitor patients daily for management of infection, pain, ventilator settings, and medication and nutrition needs, among other aspects of care.
AHA scientific statement recommends best practices to help reduce complications in the cardiac ICU environment with many principles borrowed from other medical and surgical ICU settings.
The checklist includes strategies to optimize care and prevent complications related to:
- infections;
- pain management;
- ventilator complications;
- lack of mobilization (early mobilization is recommended for the majority of patients);
- gastrointestinal complications and proper nutrition;
- medication use and errors;
- device use; and
- inclusion of the appropriate specialists for multidisciplinary care.
Main recommendations include-
- Hand hygiene to prevent hospital-acquired infections
- Adhering to safe mechanical ventilation parameters to prevent ventilator complications (e.g., keeping tidal volume at 6-10 mL/kg ideal body weight for most patients and tailoring applied positive end-expiratory pressure to each patient's underlying pathophysiological condition)
- Early mobilization for most patients (except those with active ischemia or infarction) to prevent muscle weakness.Mobilization protocols can help improve physical functioning, decrease time on a ventilator and shorten a hospital stay.
- Early initiation of enteral nutrition in most people who are unable to eat and providing stress ulcer prophylaxis for those at increased risk of gastrointestinal bleeding
- Routine screening for delirium and minimizing the use of benzodiazepines and other medications associated with delirium
- Invasive diagnostic and therapeutic procedures should be anticipated and performed before they become emergency, and any invasive catheter or mechanical circulatory support device removed promptly when no longer needed.
This scientific statement focuses on the potentially preventable complications encountered within contemporary CICUs.
'Cardiac critical care is a growing field, and there is an urgent need to implement strategies to optimize care among patients admitted to the CICU," said Fordyce, chair of the writing group for the Scientific Statement."These strategies can help CICU professionals anticipate and prevent complications in this unique patient population, and we encourage critical care teams to reflect upon their current practices and consider implementing these strategies where any gaps exist."
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