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Welcome to our resource center for advancing the knowledge and understanding of cardiology, cardiothoracic surgery and critical care.  This website is intended for multidisciplinary learners with a on issues encountered in both general critical care, cardiology and those unique to this population.

Critical care, defined as the diagnosis and management of life-threatening conditions that require close or constant attention by a group of specially trained health professionals, is inherent to the practice of cardiovascular medicine. The development of new technologies has heavily influenced the practice of critical care in cardiovascular medicine. As a result, physicians in the modern cardiac ICU must be experienced in managing the use and complications of advanced medical technologies, including noninvasive and invasive hemodynamic monitoring tools, complex modes of mechanical ventilation, renal replacement therapies, imaging guidance for bedside vascular procedures, methods of therapeutic hypothermia, and mechanical circulatory support. In addition, the growing populations of patients with severe pulmonary hypertension and advanced structural heart disease merit particular consideration in the formulation of a blueprint to meet the expanding needs of the cardiac ICU population.

Attention to the organizational environment in the ICU is essential to ensure the best practice of critical care medicine. Specialized critical care nurses are essential to high-quality ICU care in addition, as the medical complexity of the patient population has increased, so too has the complexity of pharmacotherapy, with increased potential for adverse drug events and drug-drug interactions. The addition of pharmacists to the critical care team has been associated with lower rates of adverse drug events and complications related to drug therapy, lower mortality rates in the ICU, and shorter length of hospital stay. As the profession of pharmacy has moved from a product-focused to a patient-focused one, pharmacists have been successful in protocol development and implementation, therapeutic drug monitoring, adverse drug event surveillance and reporting, orchestration of clinical trials, and provision of drug information within the ICU setting. Nutritional management of critically ill cardiovascular patients, particularly those with multiple coexisting disorders, is challenging. Dieticians evaluate dietary intake, formulate tailored nutritional delivery, and help patients to attain or maintain optimal nutritional status. Physical therapists identify and treat impairments in strength, range of motion, and potential adverse functional outcomes from prolonged critical illness. Social workers contribute to the care of the complex cardiovascular patient through counseling and case management, ensuring that patient and family goals are communicated and incorporated in transitions and discharge plans.

The substantial evidence accumulated over the past 30 years in critical care medicine may be used to guide the next phase of evolution of the cardiac ICU. Although these data were derived predominantly in general ICUs, they provide the best available information on which to base rational judgments in developing a roadmap for advancing practice in the cardiac ICU. No longer is the cardiac ICU merely a “coronary” observation unit for peri-infarction complications. Rather, the contemporary cardiac ICU is an ICU for complex patients with cardiovascular disease who become critically ill and who are more prone to major systemic complications, including renal failure, respiratory failure, thrombosis, bleeding, catheter-related infections, ventilator-acquired pneumonia, and multiorgan dysfunction. The future of cardiovascular critical care medicine is rapidly evolving, with an opportunity to improve the education and skills of clinicians and the care of their patients.

Adapted from Morrow D, et al. Evolution of Critical Care Cardiology: Transformation of the CICU and the Emerging Need for New Medical Staffing and Training Models: a Scientific Statement from the American Heart Association. Circulation. 2012 Sep 11;126(11):1408-28. Epub 2012 Aug 14.

 

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