ICU teams, daily checklists among strategies for critical heart care | CPR Classes

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ICU teams, daily checklists among strategies for
critical heart care CPR Classes
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A daily checklist, meticulous hand-cleaning and a
multidisciplinary health care team are all ways
to cut down on costly and sometimes deadly
complications in the cardiac intensive care unit,
according to a new report. The American Heart
Association scientific statement, published
Thursday in the AHA's journal Circulation, lays
out the evidence from general medical and
surgical ICUs about the care of critically ill
heart patients to help improve outcomes. "Patient
s admitted to cardiac intensive care often have
serious, non-cardiovascular conditions, such as
lung, kidney or liver disease, increasing their
risk for complications," Dr. Christopher B.
Fordyce said in a news release. He is chair of
the writing group for the statement, as well as
director of the cardiac intensive care unit at
Vancouver General Hospital in Canada.
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"Cardiac patients require increasingly complex
care, and it is important for cardiovascular
health care professionals to be experts in
treating both cardiovascular and
non-cardiovascular conditions, and to understand
ways to prevent complications in the CICU,"
Fordyce said. Coordinated care for cardiac ICU
patients should include a multidisciplinary
medical team of professionals across specialties,
as well as use of a daily, bedside checklist
during patient rounds, the report said.
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The checklist includes strategies to improve care
and prevent complications related to
infections pain management ventilator
complications lack of mobility and movement
gastrointestinal complications and proper
nutrition medication use and errors device
use inclusion of the right specialists In
addition to hand hygiene, the statement suggested
proper cleaning and stringent disinfection of
equipment and the environment.
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In addition to hand hygiene, the statement
suggested proper cleaning and stringent
disinfection of equipment and the
environment. Monitoring and support devices
used in the cardiac ICU also are a source of
potential infection. These include catheters,
mechanical circulatory support and ventilators.
The longer devices are used, the higher the
infection risk. So, the statement recommends
monitoring their length of use, as well as paying
special attention to intravenous access sites and
catheter placement. Because more than 25 of
cardiac ICU patients need mechanical ventilation,
the statement suggests doctors consider
noninvasive ventilation through a face or nose
mask, sometimes called positive pressure
ventilation. It also recommended daily,
spontaneous breathing trials to test the
patient's ability to breathe with little or no
help, allowing doctors to identify who is able to
be taken off ventilator support.
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As many as one-third of critically ill cardiac
patients experience ICU-acquired muscle weakness,
which can be reduced with early, progressive
mobilization. The report's authors said creating
mobilization protocols can help improve physical
functioning, decrease time on a ventilator and
shorten a hospital stay. Other potential trouble
spots are malnutrition, high blood sugar and
stress ulcers, which are associated with
increased time in the hospital, readmission,
infection and sometimes death. The statement
authors said sticking to the checklist can cut
down on gastrointestinal and feeding
complications, medication errors and adverse drug
reactions that can be prevalent in ICU settings.
Using the lowest effective dose also can cut down
on potential side effects from the high-risk
cardiovascular medicines frequently prescribed in
the intensive care unit.
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The key to preventing complications is to try to
anticipate and avoid emergency procedures when
possible, Fordyce said. "Rates of infections and
other complications are higher in urgent
procedures." Learn more about CPR Classes.
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