This chapter describes broad principles that ensure optimal and consistent postoperative and postprocedural care in the cardiac intensive care unit (CICU). Most patients admitted to the CICU undergo multiple diagnostic and therapeutic procedures. An organized physician and nursing leadership structure is central to the delivery of optimal multidisciplinary care in the CICU (see Fuster and Hurst's Central Illustration). Most clinical issues to be addressed in postprocedural and postoperative settings are well described and can be easily anticipated and prevented by the adoption of evidence-based standard operating protocols and implantation bundles, which ensure consistency and optimal outcomes. Protocol creation should involve a multidisciplinary team including physicians, nurses, and other relevant ancillary medical personnel. Some common clinical areas addressed include provision of analgesia, prevention of infection, screening for and treatment of delirium, sedation for mechanical ventilation, early mobilization and prevention of deep venous thrombosis, and adequate glycemic control. The utilization of checklists and the ability to promptly recognize and treat complications is crucial.
Although only 10% to 15% of patients are admitted to the cardiac intensive care unit (CICU) solely for postprocedural observation, most patients admitted to the unit undergo multiple diagnostic and therapeutic procedures.1 Procedural advances in cardiology have dramatically improved outcome amongst significant clinical subsets admitted to the CICU. This is best exemplified by the routine utilization of primary percutaneous coronary intervention (PCI) in patients presenting with ST-elevation myocardial infarction (STEMI). Adoption of this strategy, has dramatically lowered mortality while markedly reducing the likelihood of electrical and hemodynamic complications to such a profound degree that a significant proportion of STEMI subjects may now be considered for direct admission to a regular nursing floor, bypassing the CICU itself.2 While the decision to monitor specific patients following a procedure or cardiac surgery in the CICU will be guided in large part by local circumstance and policies, the broad principles to ensure optimal and consistent postoperative and postprocedural care will be highlighted in this chapter. The management of procedure specific issues to be anticipated/encountered in the postoperative and postprocedural environment will be detailed in the individual chapters addressing these topics.
ORGANIZATION OF THE CARDIAC INTENSIVE CARE UNIT
Having an organized leadership structure is central to the delivery of optimal care in the CICU.
The CICU should ideally be led by a physician leader with expertise/special interest in cardiac critical care and with familiarity in the management of the heterogeneous group of cardiac disorders that may populate this unit. The physician leader should lead a diverse group of medical professionals including but not limited to nursing, advanced nurse practitioners, respiratory therapy, pharmacy, occupational and physical therapy, social services and nutritional services, palliative care, and bioethics. The physician leader should be tasked with day-to-day administration of ...