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What’s New in the
Patient Safety World
November
2020
Prevention of Complications
in the Cardiac Intensive Care Unit
The American Heart Association has just released a scientific statement “Prevention of Complications in the Cardiac Intensive Care Unit” (Fordyce 2020). The suggested practices for cardiac intensive care units (CICU’s) are based primarily on evidence generated from patients admitted to general medical or surgical ICU’s but take into account the special circumstances and underlying conditions that CICU patients have. They recognize there has been “substantial heterogeneity in care of critically ill cardiac patients” and note that this document aims to provide standardized approaches to preventive care using the best available evidence. It suggests the use of a bedside checklist to inform best practices in the prevention of complications in this unique population.
Details of the topics in this comprehensive 28-page document are beyond the scope of today’s column. The topics are arranged under the following categories:
PREVENTION OF CICU-ACQUIRED INFECTIONS
- Prevention of Percutaneous MCS
(mechanical circulatory support)
- Device–Related Infections
- Prevention of CLABSI
- Prevention of VAP
- Prevention of CAUTI
- Prevention of Other HAI’s
- Antibiotic Stewardship and Prevention of
Antibiotic Resistance
APPROACH TO ANALGESIA AND SEDATION AND THE DIAGNOSIS AND PREVENTION OF DELIRIUM
- General Approach: ABCDEF Bundle
- Pain and Analgesia
- Delirium
- Anxiety and Agitation
- Sedative Agent Selection
- Ventilatory Dyssynchrony
and Shivering: Neuromuscular Blocker Use
PREVENTION OF VENTILATOR COMPLICATIONS
- Tidal Volume
- Positive End-Expiratory Pressure
- Oxygen Supplementation
- Daily SBT’s (spontaneous breathing
trials) and Other Strategies for Successful Extubation
- Appropriate Use of Noninvasive PPV
- Intubation/PPV-Associated Hemodynamic Compromise
BENEFITS OF EARLY MOBILIZATION
- Defining Mobilization
- Potential Benefits of Early Mobilization
- Safety and Risks of Early Mobilization
- Patient Eligibility for Early
Mobilization and Criteria for Termination of Therapy
PREVENTION OF GASTROINTESTINAL COMPLICATIONS
- Feeding
- Gastrointestinal Bleeding Prophylaxis
- Hyperglycemia Management and Prevention
of Hypoglycemia
PREVENTION AND RECOGNITION OF MEDICATION COMPLICATIONS AND ERRORS
- Anticoagulation
- Antiarrhythmic Therapy
- Vasoactive Medications
COMPLICATIONS OF INVASIVE CARDIAC PROCEDURES AND DEVICES
TRANSITIONS OF CARE BEST PRACTICES
- Multidisciplinary Rounding
- Palliative Care
- Role of Cardiac Intensivists
The document also provides a sample “Daily Bedside Checklist” to encourage best practices and to prevent complications for patients admitted to the cardiac intensive care unit (CICU). It has reminders sorted into the major categories noted above.
This is a very useful and timely document and comes with 150 references. We hope you’ll read the details of each topic and implement their suggested best practices.
References:
Fordyce CB, Katz JN, Alviar CL, et al. Prevention of Complications in the Cardiac Intensive Care Unit: A Scientific Statement From the American Heart Association. Circulation 2020; Published online 29 October 2020
https://www.ahajournals.org/doi/10.1161/CIR.0000000000000909
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