New strategies for critical cardiac care in the intensive care unit...

New strategies for critical cardiac care in the intensive care unit...
New strategies for critical cardiac care in the intensive care unit...
Embargo until 4 a.m. CT / 5 p.m. ET Thursday, October 29, 2020

DALLAS, October 29, 2020 – Cardiac Intensive Care Units (CICUs) patients could benefit from the CICU health care team by using a daily checklist to help prevent infections and other common complications. This emerges from a new scientific statement from the American Heart Association, “Prevention of Complications in the Cardiac Intensive Care Unit,” published today in the association’s flagship magazine Circulation. This statement reviews evidence from general medical and surgical intensive care units to identify ways to apply it to care for critically ill cardiac patients and improve ICU outcomes.

“Patients admitted to the ICU often have serious non-cardiovascular diseases such as lung, kidney, or liver disease, which increases the risk of complications,” said Christopher B. Fordyce, MD, MHS, M.Sc., Chairman of the Scientific Statement Writing Group, Assistant Professor in the Department of Cardiology at the University of British Columbia, and Director of the Cardiac Intensive Care Unit at Vancouver General Hospital in Vancouver, Canada. “Heart patients require increasingly complex care, and it is important that cardiovascular health professionals are experts in treating cardiovascular and non-cardiovascular diseases and understand ways to prevent complications in the intensive care unit.”

Coordinated care for CICU patients involves a multidisciplinary team of health professionals from various disciplines. The use of a daily bedside checklist during patient rounds is recommended to provide standardized approaches to preventive care.

The checklist contains strategies for optimizing care and avoiding complications related to:

  • Infections;
  • Pain therapy;
  • Ventilator complications; l
  • Confirmation of mobilization (early mobilization is recommended for the majority of patients);
  • gastrointestinal complications and proper nutrition;
  • Drug use and mistakes;
  • Device usage; and
  • Inclusion of suitable specialists for multidisciplinary support.

Hand hygiene is a mainstay of infection prevention, and intensive care units should monitor the presence of pathogens. Other preventive strategies include proper cleaning and rigorous disinfection of equipment and the environment.

Monitoring and support devices used in the intensive care unit are also a potential source of infection. These include catheters, mechanical circulatory support, and ventilators. The longer these devices are used, the higher the risk of infection for these patients. Invasive devices should be used as briefly as possible to reduce the risk of infection. Paying special attention to intravenous access sites, catheter placement, and monitoring for infection can reduce device-related infections and complications.

For mechanical ventilation that is required by more than 25% of CICU patients, non-invasive positive pressure ventilation (e.g., ventilation through a nasal mask, face mask, or nasal plug) should be considered. Daily, spontaneous breathing attempts are important to test the patient’s ability to breathe with minimal or no ventilatory assistance. This enables early identification of patients who are ready to be removed from the ventilator.

Fordyce added, “A key tenet in preventing complications in the intensive care unit is to anticipate the need for invasive procedures and equipment to avoid emergency response whenever possible. The infection rates and other complications are higher with urgent procedures. ”

Up to a third of critically ill cardiac patients suffer from muscle weakness acquired in the intensive care unit, which can be reduced by early, progressive mobilization. Mobilization protocols can help improve physical functioning, reduce ventilation time, and reduce hospital stays.

Routine compliance with the checklist can also help minimize gastrointestinal complications, feeding complications, medication errors, and adverse drug events that are prevalent in intensive care units. Malnutrition, hyperglycemia, and stress ulcers – often in the intensive care unit – are associated with undesirable outcomes, including lengthy hospital stays, readmission, infection, and hospital mortality. In addition, using the lowest effective dose of medication minimizes the potential adverse effects of the high-risk cardiovascular drugs commonly prescribed in the intensive care unit.

“Cardiac critical care is a growing field and there is an urgent need to implement strategies to optimize patient care in the intensive care unit,” said Fordyce. “These strategies can help CICU professionals anticipate and prevent complications in this unique patient population, and we encourage intensive care teams to reflect on their current practices and consider implementing these strategies if there are gaps.”

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The scientific statement was developed by the writing group on behalf of the American Heart Association’s Committee on Acute Heart Care and General Cardiology of the Council on Clinical Cardiology. Council on Atherosclerosis, Thrombosis and Vascular Biology; Cardiovascular and Stroke Care Council; Cardiopulmonary, Critical Care, Perioperative, and Resuscitation Council; and the stroke council.

Co-authors and members of the writing committee are Dr. Jason N. Katz, MHS, FAHA, vice chairman; Carlos L. Alviar, MD; Cynthia Arslanian-Engoren, Ph.D., RN, FAHA; Erin A. Bohula, MD, D. Phil .; Bram J. Geller, MD; Steven M. Hollenberg, MD, FAHA; Jacob C. Jentzer, MD, FAHA; Daniel B. Sims, MD, FAHA; Jeffrey B. Washam, Pharm.D., FAHA; and Sean van Diepen, MD, M.Sc., FAHA. Information on the author can be found in the manuscript.

Additional resources:

The available multimedia content is in the right column of the release link – https: //.Newsroom.Heart.org /News/New-strategies-proposed-for-critical-heart-care-in-the-icu? Preview =b4d114367b89aa4aa82bd9d8e359a7a1

After 4 p.m. CT / 5 p.m. ET Thursday, October 29, 2020, view the manuscript online.

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The association receives funds mainly from individuals. Foundations and corporations (including pharmaceuticals, device manufacturers, and others) also donate and fund specific association programs and events. The association has strict guidelines to prevent these relationships from affecting the scientific content. The income of pharmaceutical and biotech companies, device manufacturers and health insurance companies can be found here. The general financial information of the association can be found here.

Via the American Heart Association

The American Heart Association is a relentless force for a world with longer, healthier lives. We are committed to fair health in all communities. Working with numerous organizations and with the support of millions of volunteers, we fund innovative research, advocate public health, and share life-saving resources. The Dallas-based organization has been a premier source of health information for nearly a century. Contact us on heart.org, , Twitter, or by calling 1-800-AHA-USA1.

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