Hehir David A, Easley R Blaine, Byrnes Jonathan
Nemours Cardiac Center, AI Dupont Hospital for Children, Thomas Jefferson Medical College, Philadelphia, PA, USA
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.
World J Pediatr Congenit Heart Surg. 2016 Mar;7(2):199-209. doi: 10.1177/2150135115615847.
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.
心脏重症监护病房（CICU）收治后的预后受到多种因素影响，包括初始心脏诊断、手术复杂性以及危重病负担。此外，非心脏问题的存在可能对重症监护病房住院期间及之后的预后和患者体验产生重大影响。本综述聚焦于影响CICU内外预后和患者体验的三个常见非心脏领域：喂养与生长、疼痛与镇痛以及抗凝。生长发育不良和喂养功能障碍在需要心脏手术的婴儿中很常见，并且与更差的手术和发育预后相关。最近的研究，尤其是在单心室人群中的研究表明，实施喂养方案后体重增加和预后得到改善。接受心脏手术的儿童可能会经历急性和慢性疼痛。新出现的研究正在调查镇静剂和镇痛药对神经发育预后和生活质量的影响。改善疼痛评分以及对疼痛和戒断进行标准化管理可能会改善患者体验和预后。有效的抗凝是围手术期护理的关键组成部分，但可能因炎症、多器官功能障碍和患者因素而变得复杂。本文综述了抗凝监测的进展和新出现的治疗方法。
