Advances in cardiac intensive care.

PURPOSE OF REVIEW: As surgical survival in children with congenital heart disease, particularly those with univentricular hearts, has improved in recent years, focus has shifted to reducing the morbidity of congenital cardiac malformations and their treatment. This review will focus on emerging therapies aimed at reducing these morbidities in the intensive care unit.

RECENT FINDINGS: A protracted stay in the intensive care unit after cardiac surgery is a risk factor for developing various morbidities. Therapies or interventions that may hasten postoperative recovery and minimize the length of stay are thus important to evaluate. Fluid overload, renal dysfunction, low cardiac output and neurological dysfunction remain major contributors to morbidity after cardiac surgery. In addition, the treatment of these adverse states can potentially compound the injury.

SUMMARY: The reduction in morbidity after cardiac surgery remains challenging. Recent insights have allowed us to recognize the impact of factors beyond the intraoperative period as significant contributors to morbidity. As our field continues to evolve, future studies should focus on emerging technologies and therapies that facilitate the prevention of physiological states that compound congenital morbidities.