Program Code: SCF-DBI-PCICU-RECOVERY-0001**
Operational Window: Physiologic Stabilization → Recovery Phase → Step-Down → Discharge → Longitudinal Follow-Up
Primary Objective: Restore cardiovascular resilience, preserve neurodevelopment, optimize growth, support functional recovery, and ensure successful transition from critical illness to long-term adaptive health.
SECTION 11.1
CLINICAL POSITIONING
Traditional Cardiac Recovery Model
Recovery is often defined as:
Extubation
ICU discharge
Stable cardiac function
Hospital discharge
SCF-DBI Recovery Model
Recovery is defined as restoration of:
Neurocardiac Intelligence
Neurovascular Intelligence
Developmental Intelligence
Functional Intelligence
Growth Intelligence
Family Recovery Intelligence
Core Principle
The endpoint of recovery is not survival.
The endpoint is restoration of future adaptive potential.
SECTION 11.2
PCICU RECOVERY INTELLIGENCE PROGRAM (PRIP)
Strategic Objective
Coordinate recovery from ICU admission through long-term follow-up.
Recovery Domain 1
Cardiovascular Recovery
Recovery Domain 2
Neurodevelopmental Recovery
Recovery Domain 3
Endothelial Recovery
Recovery Domain 4
Growth Recovery
Recovery Domain 5
Functional Recovery
Recovery Domain 6
Educational Recovery
Recovery Domain 7
Family Recovery
SECTION 11.3
CARDIAC RECOVERY READINESS INDEX (CRRI)
Purpose
Determine readiness for:
Ventilator liberation
Step-down transfer
Hospital discharge
Community reintegration
Assessment Domains
Hemodynamic stability
Cardiac reserve
Recovery trajectory
Functional status
Family preparedness
Classification
Green
CRRI >80
Ready for advancement
Yellow
CRRI 60–79
Recovery optimization required
Orange
CRRI 40–59
Delayed recovery risk
Red
CRRI <40
High vulnerability
SECTION 11.4
VENTILATOR LIBERATION AFTER CARDIAC SURGERY SOP
Strategic Position
Extubation represents:
Cardiopulmonary Adaptation Milestone
Readiness Domains
Cardiac
Stable output
Stable rhythm
Stable perfusion
Respiratory
Adequate gas exchange
Pulmonary adaptation
Airway protection
SCF
Stable ANMS
Stable NCRS
Improving EII
Liberation Pathway
Mechanical Ventilation
↓
Non-Invasive Support
↓
Low-Flow Support
↓
Independent Respiration
SECTION 11.5
EARLY MOBILITY & CARDIAC REHABILITATION PROGRAM
Strategic Objective
Prevent:
ICU-acquired weakness
Functional decline
Delayed recovery
Developmental disruption
Rehabilitation Levels
Level 0
Passive mobilization
Level 1
Bed activities
Level 2
Sitting activities
Level 3
Standing activities
Level 4
Ambulation
Level 5
Age-appropriate physical participation
SECTION 11.6
RHENOVA CARDIAC REHABILITATION PLATFORM
Recovery Domain A
Cardiac Endurance Recovery
Recovery Domain B
Musculoskeletal Recovery
Recovery Domain C
Neurodevelopmental Recovery
Recovery Domain D
Exercise Capacity Recovery
Recovery Domain E
Psychosocial Recovery
Monitoring Variables
Exercise tolerance
Functional capacity
Recovery trajectory
SECTION 11.7
NEURODEVELOPMENTAL PRESERVATION PROGRAM
Clinical Positioning
Cardiac critical illness may affect:
Cognitive development
Language development
Executive functioning
Learning capacity
Behavioral adaptation
Surveillance Domains
Cognitive performance
Developmental milestones
Educational readiness
Social adaptation
Primary Output
Cardiac Neurodevelopment Index (CNI)
SECTION 11.8
GROWTH & NUTRITION INTELLIGENCE PLATFORM
Strategic Objective
Protect developmental growth trajectories.
Growth Domains
Weight gain
Linear growth
Head circumference
Nutritional adaptation
Metabolic resilience
Monitoring Variables
Growth velocity
Nutritional intake
MAS
Recovery progression
Growth Risk Categories
Green
Normal progression
Yellow
Growth vulnerability
Orange
Growth delay risk
Red
Severe growth impairment risk
SECTION 11.9
DEVELOPMENTAL CARDIOLOGY RECOVERY PATHWAY
High-Risk Populations
Single ventricle patients
Neonatal cardiac surgery
ECMO survivors
Transplant recipients
Prolonged ICU admissions
Longitudinal Monitoring
Developmental assessments
Educational assessments
Functional assessments
Quality-of-life assessments
SECTION 11.10
SCHOOL REINTEGRATION FRAMEWORK
Strategic Objective
Restore participation in age-appropriate education.
Assessment Domains
Cognitive readiness
Physical readiness
Endurance readiness
Psychosocial readiness
Reintegration Levels
Level 1
Home-based education
Level 2
Partial participation
Level 3
Modified attendance
Level 4
Full participation
SECTION 11.11
FAMILY RECOVERY INTELLIGENCE PROGRAM
Objectives
Prepare caregivers for:
Medication management
Activity supervision
Recovery monitoring
Educational advocacy
Long-term adaptation
Core Components
Family education
Discharge planning
Psychosocial support
Longitudinal engagement
SECTION 11.12
RHENOVA CARDIAC RECOVERY INTELLIGENCE TRANSFER PACKAGE (CRITP)
Purpose
Provide continuity across transitions of care.
Package Components
Clinical Summary
Diagnosis
Procedures
ICU course
Recovery milestones
Intelligence Summary
ANMS trajectory
NCRS trajectory
EII trajectory
CAI trajectory
CRRI trajectory
Recovery Summary
Functional status
Neurodevelopmental status
Growth status
Rehabilitation plan
SECTION 11.13
STEP-DOWN TRANSITION SOP
Transfer Criteria
Stable cardiac function
Stable perfusion
Stable rhythm
Positive recovery trajectory
CRRI >80
Required Handoff Domains
Cardiac status
Recovery status
Rehabilitation status
Family readiness
SECTION 11.14
LONGITUDINAL CARDIAC RECOVERY SURVEILLANCE
Follow-Up Windows
Discharge
↓
30 Days
↓
90 Days
↓
6 Months
↓
12 Months
↓
Annual Review
Surveillance Domains
Cardiac performance
Neurodevelopment
Growth
Exercise capacity
Educational participation
Psychosocial adaptation
SECTION 11.15
RECOVERY SUCCESS ENDPOINTS
Clinical
Stable cardiovascular function
Reduced rehospitalization
Reduced complications
Functional
Age-appropriate activity participation
Exercise tolerance restoration
Educational participation
Developmental
Preserved neurodevelopment
Preserved growth trajectories
Preserved psychosocial adaptation
Biological Intelligence
ANMS >80
NCRS >80
EII >80
CAI >80
CNI >80
CRRI >80
Sustained recovery trajectory
PAGE 11 COMPLETION
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