Program Code: SCF-DBI-PCICU-ADMIT-0001**
Operational Window: OR/ED/Cath Lab Arrival → First 6 Hours of PCICU Care
Primary Objective: Establish cardiovascular stability, preserve neurocardiac intelligence, prevent low cardiac output syndrome (LCOS), and initiate recovery intelligence surveillance immediately upon admission.
SECTION 2.1
PCICU ADMISSION ACTIVATION CRITERIA
Direct PCICU Admission
Neonatal Cardiac Surgery
Infant Cardiac Surgery
Complex Congenital Heart Disease
Cardiogenic Shock
Acute Heart Failure
Fulminant Myocarditis
Pulmonary Hypertensive Crisis
ECMO Support
Ventricular Assist Device Support
Cardiac Transplantation
High-Risk Arrhythmias
SECTION 2.2
CARDIAC SURGERY TO PCICU HANDOFF SOP
Objective
Ensure uninterrupted biologic intelligence surveillance during transition.
Required Surgical Report
Procedure Performed
Surgical diagnosis
Procedure details
Intraoperative findings
Cardiopulmonary Bypass Data
Bypass duration
Cross-clamp duration
Circulatory arrest duration
Cerebral perfusion strategy
Intraoperative Events
Arrhythmias
Hemodynamic instability
Bleeding events
Transfusion requirements
Immediate Concerns
Ventricular dysfunction
Residual lesions
Pulmonary hypertension
Bleeding risk
SECTION 2.3
SCF-DBI CARDIAC HANDOFF REQUIREMENTS
Neurocardiac Review
Ventricular function
Cardiac output
Hemodynamic reserve
Neurovascular Review
Perfusion status
NIRS values
Endothelial burden
Neuroimmune Review
Inflammatory burden
Surgical stress burden
Recovery Intelligence Review
Expected recovery trajectory
Risk factors
Rehabilitation considerations
SECTION 2.4
CONGENITAL HEART DISEASE RISK STRATIFICATION
Tier I
Low Complexity
Examples:
ASD
VSD
PDA
Tier II
Moderate Complexity
Examples:
Tetralogy of Fallot
Partial AV Canal
Pulmonary Valve Disease
Tier III
High Complexity
Examples:
Complete AV Canal
Arterial Switch Procedures
Truncus Arteriosus
Tier IV
Critical Complexity
Examples:
HLHS
Single Ventricle Physiology
Norwood Procedures
Complex Neonatal Repairs
SECTION 2.5
IMMEDIATE POSTOPERATIVE CARDIAC ASSESSMENT
Assessment Window
Within:
15 Minutes of PCICU Arrival
Cardiac Assessment
Evaluate:
Heart rate
Rhythm
Blood pressure
Ventricular function
Filling pressures
Perfusion Assessment
Evaluate:
Lactate
Capillary refill
Urine output
Temperature gradients
NIRS
Respiratory Assessment
Evaluate:
Ventilation
Oxygenation
Pulmonary pressures
Airway status
Neurologic Assessment
Evaluate:
Pupils
Cerebral oxygenation
Sedation status
Neurologic risk factors
SECTION 2.6
LOW CARDIAC OUTPUT SYNDROME (LCOS) EARLY DETECTION FRAMEWORK
Strategic Position
LCOS is viewed as:
Neurocardiac Adaptation Failure Syndrome
Early Warning Indicators
Rising lactate
Falling NIRS
Reduced urine output
Widening temperature gradients
Tachycardia
Increasing vasoactive support
LCOS Severity Classification
Stage I
Compensated
Stage II
Threatened
Stage III
Decompensated
Stage IV
Critical
SECTION 2.7
POSTOPERATIVE ANMS BASELINE ESTABLISHMENT
Purpose
Create immediate postoperative biologic intelligence profile.
Neuroimmune Domain
Assess:
CRP
CBC
Inflammatory burden
Surgical stress burden
Neurocardiac Domain
Assess:
Lactate
Cardiac output
Ventricular performance
Neurovascular Domain
Assess:
NIRS
Perfusion
Endothelial stress
Neurometabolic Domain
Assess:
Glucose
Acid-base status
Energy utilization
Neuroendocrine Domain
Assess:
Stress burden
Recovery reserve
SECTION 2.8
RHENOVA PROCEDURE ACTIVATION PROTOCOL
Activation Window
0–6 Hours
Procedure 1
Neurocardiac Preservation Bundle
Activate for:
All postoperative cardiac surgery patients
Myocarditis
Cardiogenic shock
Transplant recipients
Immediate Actions
Continuous NIRS
Lactate surveillance
Perfusion optimization
Recovery planning
Procedure 2
Endothelial Preservation Bundle
Activate for:
Cardiopulmonary bypass patients
ECMO
LCOS risk
Shock risk
Immediate Actions
Perfusion optimization
Fluid stewardship
Endothelial surveillance
Procedure 3
Cardiac Recovery Platform
Activate for:
Anticipated ICU stay >48 hours
Complex congenital repairs
Transplant patients
Immediate Actions
Nutrition planning
Rehabilitation planning
Family integration
SECTION 2.9
POSTOPERATIVE HEMODYNAMIC CLASSIFICATION
Green Zone
Stable adaptation
Characteristics:
Normal perfusion
Stable lactate
Stable NIRS
Yellow Zone
Adaptive stress
Characteristics:
Mild lactate elevation
Increased vasoactive requirements
Orange Zone
Threatened adaptation
Characteristics:
Worsening perfusion
Declining NIRS
LCOS risk
Red Zone
Critical adaptation failure
Characteristics:
Progressive shock
Severe ventricular dysfunction
Rescue activation required
SECTION 2.10
PCICU COMMAND CENTER ENROLLMENT
Every Admission Enrolled Into
ANMS
NCRS
EII
STRI
CAI
Recovery Intelligence Dashboard
Dashboard Status Categories
Stable
Watch
Escalation
Rescue
Recovery
SECTION 2.11
FIRST SIX-HOUR CLINICAL OBJECTIVES
Cardiac
Optimize cardiac output
Stabilize rhythm
Preserve ventricular function
Perfusion
Normalize lactate
Improve tissue oxygenation
Preserve endothelium
Neurologic
Preserve cerebral oxygenation
Prevent secondary injury
Recovery
Begin recovery intelligence planning
Establish expected recovery trajectory
SECTION 2.12
ESCALATION CRITERIA
Immediate Escalation
Any of the following:
Lactate rising >20%
NIRS declining >15%
ANMS decline >15%
NCRS decline >15%
New arrhythmia
Ventricular dysfunction worsening
Increasing vasoactive requirements
SECTION 2.13
ADMISSION ENDPOINTS
Clinical
Hemodynamic stabilization
Adequate oxygen delivery
Stable rhythm
SCF
ANMS baseline completed
NCRS baseline completed
EII baseline completed
Recovery trajectory established
RHENOVA
All indicated bundles activated
Recovery intelligence pathway initiated
PAGE 2 COMPLETION
Next Page (Page 3):