| |
Goals |
Recommendations |
| Hemodynamics Vital Signs |
- HR < 160
- SBP > 60
- DBP > 30
- MAP > 40
- Urine output ≥ 0.5 mL/kg/hr
- Begin furosemide IV POD1
- pH 7.35-7.45, minimal base deficit
|
- Titrate infusions:
- Dopamine: 3-5 mcg/kg/min
- Milrinone: 0.3-0.5 mcg/kg/min
- Epinephrine: 0.01- 0.05 mcg/kg/min
- Discontinue for adverse effect or when no longer needed
- IV fluids at maintenance rate
- If cardiac output inadequate, obtain echocardiogram and ECG
- Low-grade fever within first 24 hrs is common after bypass. For fever outside this window, refer to CICU Fever Guidelines
|
| Respiratory |
- Normal work of breathing
- pH 7.35-7.45
- CO2 < 45
- Consider extubation when:
- PEEP 3-6
- Rate 5-10
- Pressure support 5-10
|
- Initial vent settings discussed at handoff
- Potential barriers to extubation include
- Bleeding
- Hemodynamic instability (low cardiac output, arrhythmias)
- Decreased level of consciousness
|
| Neurologic |
- Video EEG
- Within 6 hrs of CICU arrival
- Continue for 48 hrs
|
If seizures detected, discuss treatment with Neurology |
| Diagnostic Studies |
- CXR
- Upon CICU arrival
- POD 1
- After removal of thoracic lines, drains
- ABG
- Upon CICU arrival
- Q1hr x 2
- Q2hr x 2
- Q4hr for remainder of first 24 hrs
|
|
| Pain Management |
- Maintain analgesia and anxiolysis
|
|
| Nutrition |
Follow Clinical Pathway: Nutrition in Neonates after Surgery for CHD |
| Hemostasis |
- Hemostasis commonly achieved upon CICU arrival
- Routine coagulation profile not routinely indicated
|
- For ongoing bleeding:
- Avoid hypertension
- Obtain CBC, INR/PT/ PTT/fibrinogen
- Maintain:
- Hgb > 10 g/dL
- Fibrinogen > 150
- Platelets > 100
- PT < 15
- PTT < 50
- Notify surgeon
- Repeat labs as indicated
|