SCF-DBI PEDIATRIC INTENSIVE CARE UNIT (PICU) SOP | Pediatric Shock, Hemorrhagic Shock, Cardiogenic Shock, Myocarditis, Neurocardiac Intelligence & RHENOVA Cardiovascular Recovery Platform

Program Code: SCF-DBI-PICU-CV-0001

Operational Window: Recognition of Hemodynamic Instability → Recovery → Discharge

Primary Objective: Preserve cardiovascular biological intelligence, prevent progression to multi-system collapse, maintain tissue perfusion, protect neurodevelopment, and accelerate functional recovery.

SECTION 5.1

CLINICAL POSITIONING

Traditional Pediatric Shock Model

Focuses on:

Blood pressure
Cardiac output
Lactate
Fluid resuscitation
Vasopressor support

SCF-DBI Shock Model

Shock is viewed as:

Neurocardiovascular Intelligence Failure Syndrome

involving disruption of:

Neurocardiac adaptation

Neurovascular integrity

Endothelial resilience

Metabolic adaptation

Neuroimmune regulation

Recovery reserve

Core Principle

Hypotension is a late manifestation.

The primary objective is early identification of adaptive failure before irreversible organ dysfunction develops.

SECTION 5.2

PEDIATRIC SHOCK CLASSIFICATION

Class I

Adaptive Shock Stress

Characteristics:

Compensated physiology
Mild perfusion abnormalities
Preserved organ function

Class II

Threatened Shock

Characteristics:

Rising lactate
Increasing tachycardia
Perfusion abnormalities

Class III

Decompensated Shock

Characteristics:

Organ dysfunction
Significant perfusion compromise
ANMS deterioration

Class IV

Critical Shock

Characteristics:

Progressive multi-organ dysfunction
Endothelial collapse
High mortality risk

Class V

Biologic Intelligence Collapse

Characteristics:

Refractory shock
Severe ANMS failure
Rescue platform activation

SECTION 5.3

INITIAL SHOCK ASSESSMENT SOP

Assessment Window

Within:

10 Minutes of Recognition

Clinical Assessment

Evaluate:

Mental status

Capillary refill

Skin perfusion

Pulse quality

Urine output

Temperature gradients

Physiologic Assessment

Blood pressure

Lactate

Venous oxygen saturation

Cerebral oxygenation

Perfusion indices

Advanced SCF Assessment

ANMS

EII

NCRS

Recovery reserve

SECTION 5.4

HEMORRHAGIC SHOCK WORKFLOW

Clinical Positioning

Hemorrhagic shock is viewed as:

Oxygen Delivery Failure Syndrome

with secondary:

Endothelial disruption

Neurovascular compromise

Metabolic collapse

Common Etiologies

Trauma

Surgical bleeding

Gastrointestinal hemorrhage

Coagulopathy

Immediate Priorities

Hemorrhage control

Perfusion restoration

Endothelial preservation

Oxygen delivery optimization

SCF Monitoring Variables

Lactate

Hemoglobin

Perfusion

Cerebral oxygenation

EII

SECTION 5.5

CARDIOGENIC SHOCK WORKFLOW

Clinical Positioning

Cardiogenic shock represents:

Neurocardiac Pump Failure Syndrome

Common Etiologies

Myocarditis

Cardiomyopathy

Congenital heart disease

Arrhythmias

Post-cardiotomy dysfunction

Surveillance Variables

Cardiac output

Lactate

Echocardiography

BNP

Troponin

NCRS

Shock Severity Classification

Mild

Moderate

Severe

Refractory

SECTION 5.6

MYOCARDITIS CRITICAL CARE SOP

Clinical Positioning

Myocarditis is viewed as:

Immune-Mediated Neurocardiac Injury Syndrome

Core Threats

Ventricular dysfunction

Arrhythmias

Cardiogenic shock

Neurovascular instability

Recovery failure

Surveillance Program

Echocardiography

Troponin

BNP

Lactate

ANMS

NCRS

Recovery Objectives

Preserve myocardial recovery

Prevent secondary organ injury

Preserve functional resilience

SECTION 5.7

NEUROCARDIAC INTELLIGENCE MONITORING PROGRAM

Purpose

Detect deterioration before overt cardiovascular collapse.

Domain A

Cardiac Function

Monitor:

Echocardiography

Contractility

Ventricular performance

Domain B

Perfusion

Monitor:

Lactate

Urine output

Capillary refill

Tissue oxygenation

Domain C

Recovery Reserve

Monitor:

Functional improvement

Vasopressor dependence

ANMS trajectory

Output

Neurocardiac Resilience Score (NCRS)

NCRS CLASSIFICATION

Green

Stable adaptation

Yellow

Early stress

Orange

Threatened adaptation

Red

High cardiovascular collapse risk

SECTION 5.8

RHENOVA CARDIOVASCULAR RECOVERY PLATFORM

Strategic Objective

Initiate recovery during active shock management.

Recovery Domains

Neurocardiac Recovery

Endothelial Recovery

Metabolic Recovery

Cognitive Recovery

Functional Recovery

Platform Components

Early rehabilitation planning

Perfusion optimization

Sleep preservation

Nutrition optimization

Family engagement

SECTION 5.9

ENDOTHELIAL PRESERVATION IN SHOCK

Objectives

Protect:

Glycocalyx

Microcirculation

Tissue oxygenation

Organ resilience

Monitoring Variables

EII

Lactate

Perfusion

Capillary refill

Urine output

EII CLASSIFICATION

Green

Stable endothelium

Yellow

Early stress

Orange

Threatened adaptation

Red

Collapse risk

SECTION 5.10

HEMODYNAMIC ANMS FRAMEWORK

Neuroimmune Domain

Monitor:

Inflammatory burden

Infection burden

Neurocardiac Domain

Monitor:

Cardiac function

Lactate

Perfusion

Neurovascular Domain

Monitor:

EII

Oxygen delivery

Neurometabolic Domain

Monitor:

Glucose

Lactate

Energy reserve

Neuroendocrine Domain

Monitor:

Stress burden

Shock burden

SECTION 5.11

SHOCK ESCALATION MATRIX

Level 1

Enhanced Monitoring

Triggers:

Rising lactate

Perfusion abnormalities

Level 2

Focused Intervention

Triggers:

ANMS decline >15%

EII decline >15%

NCRS decline >15%

Level 3

Multidisciplinary Escalation

Triggers:

Progressive organ dysfunction

Vasopressor escalation

Level 4

Critical Rescue Activation

Triggers:

ANMS <40

Refractory shock

Multi-organ dysfunction

SECTION 5.12

ECMO BRIDGE CONSIDERATION FRAMEWORK

Indications

Refractory cardiogenic shock

Fulminant myocarditis

Refractory circulatory failure

SCF Objectives

Preserve cerebral adaptation

Preserve organ viability

Enable myocardial recovery

Monitoring

ANMS

NCRS

EII

Recovery trajectory

SECTION 5.13

CARDIOVASCULAR RECOVERY PROGRAM

Recovery Domains

Myocardial recovery

Perfusion recovery

Endothelial recovery

Cognitive recovery

Functional recovery

Recovery Monitoring

Echocardiography

Lactate

NCRS

EII

Recovery Readiness Index

SECTION 5.14

CARDIOVASCULAR RECOVERY ENDPOINTS

Clinical

Stable perfusion

Stable cardiac function

No escalating support

Functional

Activity progression

Rehabilitation readiness

Biological Intelligence

ANMS >80

NCRS normalized

EII normalized

Recovery trajectory positive

PAGE 5 COMPLETION

Next Page (Page 6):

Pediatric Neurocritical Care SOP

Status Epilepticus Workflow

Traumatic Brain Injury (TBI) SOP

Encephalitis & Meningitis Critical Care SOP

Delirium Prevention Program

Neuroprotection & Cognitive Preservation Bundle (Full Deployment)

Neurodevelopmental ANMS Framework

MASTER REGISTRY INDEX

SCF-DBI-PICU-CV-0001 — Pediatric Cardiovascular Critical Care SOP

SCF-DBI-PICU-HSHOCK-0001 — Hemorrhagic Shock Workflow

SCF-DBI-PICU-CSHOCK-0001 — Cardiogenic Shock Workflow

SCF-DBI-PICU-MYO-0001 — Myocarditis Critical Care SOP

SCF-NCRS-PICU-0001 — Neurocardiac Resilience Score

SCF-RHENOVA-CRP-0001 — Cardiovascular Recovery Platform

SCF-EII-PICU-0001 — Endothelial Intelligence Index

SCF-ANMS-CV-PICU-0001 — Hemodynamic ANMS Framework

SCF-DBI-PCR-CV-0001 — Preventative-Curative-Restorative Cardiovascular Architecture

SCF-RHENOVA-PICU-CV-0001 — Project RHENOVA Cardiovascular Intelligence Platform