title: Noncardiac Challenges in the Cardiac ICU: Feeding, Growth and Gastrointestinal Complications, Anticoagulation, and Analgesia.
abstract: Outcomes following cardiac intensive care unit (CICU) admission are influenced by many factors including initial cardiac diagnosis, surgical complexity, and burden of critical illness. Additionally, the presence of noncardiac issues may have a significant impact on outcomes and the patient experience during and following an intensive care unit stay. This review focuses on three common noncardiac areas which impact outcomes and patient experience in and beyond the CICU: feeding and growth, pain and analgesia, and anticoagulation. Growth failure and feeding dysfunction are commonly encountered in infants requiring cardiac surgery and have been associated with worse surgical and developmental outcomes. Recent studies most notably in the single ventricle population have demonstrated improved weight gain and outcomes when feeding protocols are implemented. Children undergoing cardiac surgery may experience both acute and chronic pain. Emerging research is investigating the impact of sedatives and analgesics on neurodevelopmental outcomes and quality of life. Improved pain scores and standardized management of pain and withdrawal may improve the patient experience and outcomes. Effective anticoagulation is a critical component of perioperative care but may be complicated by inflammation, multiorgan dysfunction, and patient factors. Advances in monitoring of anticoagulation and emerging therapies are reviewed.
authors.affiliation: Nemours Cardiac Center, AI Dupont Hospital for Children, Thomas Jefferson Medical College, Philadelphia, PA, USA david.hehir@nemours.org.
authors.forename: David A
authors.initials: DA
authors.lastname: Hehir
authors.affiliation: Department of Anesthesiology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA.
authors.forename: R Blaine
authors.initials: RB
authors.lastname: Easley
authors.affiliation: The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Byrnes
mesh_terms: D000698:Analgesia / Q000379:methods; D000925:Anticoagulants / Q000627:therapeutic use*; D006348:Cardiac Surgical Procedures; D002648:Child; D002675:Child, Preschool; D003325:Coronary Care Units; D020345:Enterocolitis, Necrotizing / Q000453:epidemiology*; D005183:Failure to Thrive / Q000453:epidemiology / Q000628:therapy; D005248:Feeding Methods; D006130:Growth Disorders / Q000453:epidemiology* / Q000628:therapy; D006330:Heart Defects, Congenital / Q000601:surgery*; D006352:Heart Ventricles; D006760:Hospitalization; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D059408:Pain Management; D010149:Postoperative Pain / Q000628:therapy*; D019990:Perioperative Care; D011183:Postoperative Complications / Q000453:epidemiology* / Q000628:therapy; D011788:Quality of Life; D013927:Thrombosis / Q000188:drug therapy / Q000453:epidemiology* / Q000517:prevention & control
chemical_list: D000925:Anticoagulants
keywords: blood; coagulation/anticoagulation; congenital heart disease; intensive care; nutrition; pain