Health
Heart ICU: AHA Draft Guidance for Best Practices
According to the American Heart Association (AHA), severe cardiovascular patients require special care in the cardiac ICU due to the unique complications they tend to suffer from.
Best practices that help reduce complications in the cardiac ICU environment are recommended in the AHA scientific statement. Published online circulationMany principles borrowed from other medical and surgical ICU settings:
- Hand hygiene to prevent nosocomial infections
- Regular screening for delirium and minimization of the use of benzodiazepines and other drugs associated with delirium
- Adherence to safe mechanical ventilation parameters to prevent ventilator complications (eg, keep tidal volume at an ideal weight of 6-10 mL / kg for most patients, and each patient’s radical Adjusting positive end-expiratory pressure applied to various pathophysiological conditions)
- Early recruitment of most patients (except those with active ischemia or infarction) to prevent weakness
- Provides early initiation of enteral nutrition for most people who cannot eat and prevention of stress ulcers for those at high risk of gastrointestinal bleeding
However, according to a group of authors chaired by the University of British Columbia’s Doctor of Medicine Christopher Fordyce (MHS), cardiac ICUs are unique to cardiogenic shock-related complications and invasive cardiovascular at their own risk. A special use of monitoring and support devices. Columbia and Vancouver General Hospital.
Invasive diagnostic and therapeutic procedures need to be predicted and performed before an emergency occurs, and invasive catheters or mechanical circulatory aids should be removed as soon as they are no longer needed. Have stated.
Fordyce and colleagues provided a bedside checklist for standardization Heart ICU Best Practices..
“Critical care of the heart is a growing area and there is an urgent need to implement strategies to optimize care for patients admitted to CICU. [cardiac ICU]”For Dice Press release.. “These strategies help CICU experts predict and prevent complications in this unique patient population, and the critical care team will help them. Current practice If there are gaps, consider implementing these strategies. “
The AHA writing group made recommendations after reviewing data from the general medical and surgical ICU literature, given the lack of direct evidence from cardiac ICU settings.
“In the opinion of the writing group, this extrapolation of evidence is rational given that patients with modern CICU appear to have significant overlap with concomitant medical conditions and treatments with limited critical care. The authors insisted.
According to the group, “more clearly define the epidemiology of serious disease-related complications in the CICU patient population, and use rigorous multicenter clinical trials and large future registries to develop existing and new therapies. Evaluation requires future research and quality improvement efforts. “
AHA has previously stated the need for enhanced care Especially elderly patients In the heart ICU.
Last updated: October 29, 2020
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Disclosure
Fordyce has not disclosed a relationship with the industry. Members of the writing group disclosed the relationship between Abbott’s support and Zoll Medical.
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