Prevention of Critical Care Complications in the Coronary Intensive Care Unit: Protocols, Bundles, and Insights From Intensive Care Studies.
Over the past half century, coronary care units have expanded from specialized ischemia arrhythmia monitoring units into intensive care units (ICUs) for acutely ill and medically complex patients with a primary cardiac diagnosis. Patients admitted to contemporary coronary intensive care units (CICUs) are at risk for common and preventable critical care complications, yet many CICUs have not adopted standard-of-care prevention protocols and practices from general ICUs. In this article, we (1) review evidence-based interventions and care bundles that reduce the incidence of ventilator-associated pneumonia, excess sedation during mechanical ventilation, central line infections, stress ulcers, malnutrition, delirium, and medication errors and (2) recommend pragmatic adaptations for common conditions in critically ill patients with cardiac disease, and (3) provide example order sets and practical CICU protocol implementation strategies.
Divisions of Critical Care and Cardiology, University of Alberta, Edmonton, Alberta, Canada; Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada. Electronic address: sv9@ualberta.ca.
Sean
S
van Diepen
Divisions of Critical Care Medicine and Infectious Diseases, University of Alberta, Edmonton, Alberta, Canada.
Wendy I
WI
Sligl
Duke Heart Center, Duke University Medical Center, Durham, North Carolina, USA.
Jeffrey B
JB
Washam
Milton S. Hershey Medical Center, Penn State University, Hershey, Pennsylvania, USA.
Ian C
IC
Gilchrist
Department of Surgery and Cardiac Sciences Program, University of Manitoba, Winnipeg, Manitoba, Canada.
Rakesh C
RC
Arora
Divisions of Cardiology and Pulmonary and Critical Care Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.
Jason N
JN
Katz
D003325:Coronary Care Units; D003422:Critical Care / Q000379:methods*; D016638:Critical Illness; D006331:Heart Diseases / Q000628:therapy*; D006801:Humans; D053717:Pneumonia, Ventilator-Associated / Q000517:prevention & control*