ICU and Inpatient Clinical Pathway for Children with Pulmonary Hypertension Requiring Procedure, Anesthesia or Sedation

Pre-anesthesia Assessment
  • Outpatient: Anesthesia Resource Center (ARC)
  • Inpatient: Admitting Service
  • Intake review
  • Assess number and type of PH Medication(s)
  • Emergent Case
    • Call Cardiac Anesthesia On-call:
      • PHL Anes Cardiac
      • 1st Contact
No Prostacyclins or selexipag
and
< 3 medications
Prostacyclins or selexipag
or
≥ 3 medications
Do not anticipate narcotic post-op Pain Management
Anticipate narcotic post-op Pain Management
1 medication
2 medications
OR team/Anesthesia review recovery and disposition recommendation
with proceduralist or admitting service
Recovery and Disposition Unit Considerations
  • Recovery Location
    • CPRU/PACU
  • Disposition
    • Discharge
  • Recovery Location
    • CPRU/PACU
  • Disposition
    • Med/Surg floor
    • Discharge after clearance by procedural anesthesiologist
  • Recovery Location
    • PICU/CICU/N/IICU
  • Disposition
    • PICU/CICU/N/IICU
Discharge/Transfer Criteria
  • Pain controlled, returned to baseline respiratory status
  • If not able to discharge, notify Pulmonary HTN inpatient service (day) Cardiology Fellow (night)
  • Children who were anticipated to discharge but require inpatient care
    • Procedural service admits and consults pulmonary hypertension team
    • Physician and Nursing Supervisors assist with determining appropriate bed location
Posted: May 2024
Editors: Clinical Pathways Team