Pulmonary Hypertension Requiring Procedure, Anesthesia or Sedation Clinical Pathway — ICU and Inpatient

Clinical Pathways Home Emergency ICU Inpatient Outpatient Specialty Care Primary Care

Goals and Metrics

Patient Education

Provider Resources

Related Pathway

Perioperative Care, Anesthesia/Sedation,
ED and Inpatient

Child with Pulmonary Hypertension (PH)
Requiring Procedure, Anesthesia or Sedation

PH Crisis Management

Pre-anesthesia Assessment

Outpatient: Anesthesia Resource Center (ARC)
Inpatient: Admitting Service
Intake review
Assess number and type of PH Medication(s)

Emergent Case
- Call Cardiac Anesthesia On-call:
  - PHL Anes Cardiac
  - 1st Contact

No Prostacyclins or selexipag
and
< 3 medications

Prostacyclins or selexipag
or
≥ 3 medications

Do not anticipate narcotic post-op Pain Management

Anticipate narcotic post-op Pain Management

1 medication

2 medications

OR team/Anesthesia review recovery and disposition recommendation
with proceduralist or admitting service

Recovery and Disposition Unit Considerations

Recovery Location
- CPRU/PACU
Disposition
- Discharge

Recovery Location
- CPRU/PACU
Disposition
- Med/Surg floor
- Discharge after clearance by procedural anesthesiologist

Recovery Location
- PICU/CICU/N/IICU
Disposition
- PICU/CICU/N/IICU

Discharge/Transfer Criteria

Pain controlled, returned to baseline respiratory status
If not able to discharge, notify Pulmonary HTN inpatient service (day) Cardiology Fellow (night)
Children who were anticipated to discharge but require inpatient care
- Procedural service admits and consults pulmonary hypertension team
- Physician and Nursing Supervisors assist with determining appropriate bed location

Posted: May 2024

Authors:
- A. Davidson, MD;
- D. Davis, MD;
- D. Calfin, RN;
- L. Babus, MD;
- S. Basu, FNP-C;
- S. Dubow, MD;
- S. Frese, RN;
- M. Friedman, RN;
- B. Hansell, RN;
- K. Harris, MD;
- S. Maeder-Chieffo, CRNP;
- J. McCloskey, MD;
- L. Obermeier, RN;
- J. Osborne, RN;
- M. Pearsall, MD;
- L. Stahl, RN;
- M. Tumolo, RN;
- J. Whittle, RN;
- H. Wolfe, MD

Editors: Clinical Pathways Team

Evidence

CHOP Programs

Pulmonary Hypertension Program

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

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ICU and Inpatient Clinical Pathway for Children with Pulmonary Hypertension Requiring Procedure, Anesthesia or Sedation

Evidence

CHOP Programs