THÔNG TIN TÀI LIỆU
■ Evaluation of the central nervous system ■ Feeding and nutrition ■ Deviations from the expected postoperative course ■ Evaluation and management of acute decompensation ■ Evaluation and management of failure to progress ■ Family support and discharge planning Bedside Preparedness Preparation for the arrival of a neonate following surgical intervention starts well before the child's arrival at the CICU, and communication with the team in the operating room prior to patient arrival is critical Handoff from the operating room to the CICU marks a period of particularly increased vulnerability An understanding of the ventilation strategies, monitoring lines, vasoactive medications, surgical considerations (such as delayed sternal closure and bleeding) is vital, as is excellent communication among the members of the team Each institution will utilize different strategies depending on unit experience as well as policies and procedures, although a standardized approach to environmental preparedness, equipment transfer, and information handoff is critical to optimize transitional care Important elements of environmental readiness are shown in Table 71.3 Table 71.3 Environmental Readiness Standard Equipment Ventilator Heat/warming source Monitor Infusion pumps Suction sources Chest drainage system (e.g., Pleurevac) Medications Vasoactive medications Sedation and analgesia Neuromuscular blockade (if used) Resuscitation medications Emergency Equipment Defibrillator Code or crash cart Sternal opening tray Extracorporeal membrane oxygenation circuit Airway protection and intubation equipment Invasive and Noninvasive Monitoring and Surveillance Monitoring and surveillance of the neonate with a fUVH following complex palliative surgery plays a crucial role in assessment and management Monitoring can be continuous (e.g., heart rate) or intermittent (e.g., renal function), and invasive (e.g., central venous pressure) or noninvasive (e.g., electroencephalography) Values obtained generally represent an actual value (e.g., pH), but alone or in combination all are surrogates for the adequacy of DO2, multiorgan health, and the “pace” of recovery Each center typically has a standardized strategy, although there are significant differences among centers.12,14,16,105–110 A summary of various protocols can be found in Table 71.4 (continuous monitoring) and Table 71.5 (intermittent monitoring) Table 71.4 Institution-Specific Approaches to Monitoring After Neonatal Palliation of Functionally Univentricular Hearts BostChild STAGE I NORWOOD Invasive Central venous Yes cathetera Umbilical venous Sometimes catheter Umbilical arterial Sometimes catheter Peripheral arterial Yes catheter Atrial catheter Yes Urinary catheter Yes Noninvasive Electroencephalogram Sometimes Cerebral NIRS Yes Somatic NIRS No End-tidal CO2b Yes Temperature CHOP CNMC No CCHMC RCH CSMott BirmChild Sometimes Yes No No No Yes Yes Sometimes Yes Sometimes Yes Yes No Yes Sometimes Yes Sometimes Yes Yes No Sometimes Sometimes Yes Sometimes Yes Sometimes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Sometimes Yes Yes No No Yes Yes Yes Yes Yes Sometimes Yes Yes Yes Sometimes Yes Yes Yes No Yes Yes Yes No Yes Sometimes Yes No Sometimes Sometimes Yes Esophagus Yes Bladder Skin Multi-Site Yes Yes No Yes Yes Yes Yes Yes No Yes Yes Yes MultiSite Yes Yes No Yes Yes Yes Yes Yes No No Yes Yes No N/A No Yes Yes Sometimes Yes Sometimes Yes No Yes Sometimes Yes Sometimes Yes No Esophagus Rectal Heart rate Yes Respiratory rate Yes iDO2 Yes HYBRID PROCEDURE Invasive Central venous Yes catheter* Umbilical venous Sometimes catheter Umbilical arterial Sometimes TCH catheter Peripheral arterial catheter Atrial catheter Urinary catheter Noninvasive Electroencephalogram Cerebral NIRS Somatic NIRS End-tidal CO2b Yes Sometimes Sometimes Yes Sometimes Sometimes Yes Yes Yes Sometimes Yes Yes Yes Yes Yes Yes Yes Yes Yes Sometimes Yes Sometimes Yes No Yes No No No Yes No Yes Yes Yes Sometimes N/A Yes Yes Yes No Yes Sometimes Yes No Sometimes Sometimes Yes Yes Yes Yes No Bladder Yes Yes Yes No Skin Yes Yes Yes Multisite Yes Yes No Yes Yes Yes Yes Yes Yes Yes No Yes No Yes No Yes Sometimes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Sometimes Sometimes No Yes Yes Temperature Sometimes Rectal Esophagus Yes Heart rate Yes Yes Yes Yes Respiratory rate Yes Yes Yes Yes iDO2 Yes No Yes No TOTAL CAVOPULMONARY CONNECTION (FONTAN) Invasive Fontan linec Yes Sometimes Yes Yes Common atrial Yes Yes Yes Yes catheter Peripheral arterial Yes Yes Yes Yes catheter Urinary catheter Yes Yes Yes Yes Noninvasive Cerebral NIRS Sometimes No Yes Yes Somatic NIRS No No Yes Yes End-tidal CO2b Yes Yes Yes Yes Bladder Yes Yes Yes Multisite Yes Yes No Skin Yes Yes Yes Multisite Yes Yes No Yes No Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No Sometimes No Yes Yes Temperature Heart rate Respiratory rate iDO2 Bladder Yes Yes Yes Multisite Yes Yes No Skin Yes Yes Yes No Yes Yes Yes Temperature Esophagus Rectal Esophagus Heart rate Yes Yes Yes Respiratory rate Yes Yes Yes iDO2 Yes No Yes SUPERIOR CAVOPULMONARY CONNECTION Invasive Central venous Yes No No catheter* Atrial catheter Yes Yes Yes Peripheral arterial Yes Yes Yes catheter Urinary catheter Yes Yes Yes Noninvasive Cerebral NIRS Yes No Yes Somatic NIRS No No Yes End-tidal CO2b Yes Yes Yes Sometimes Yes Yes Yes No Yes Yes No Esophagus Yes Yes Yes Yes Yes Yes No aSuperior caval vein bWhile intubated cSuperior caval vein, Fontan baffle, or pulmonary artery Multisite Yes Yes No
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