CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
64
AFRICA
Hospital, Ibadan, Nigeria
2
Department of Radiology, University College Hospital, Ibadan,
Nigeria
3
Department of Clinical Pharmacology, University College Hospital,
Ibadan, Nigeria
4
Departmeent of Clinical Chemistry, University College Hospital,
Ibadan, Nigeria
Background:
The New York Heart Association (NYHA) heart fail-
ure severity grading scale has stood the test of time in serving as a
useful clinical grading scale for the severity of heart failure, particu-
larly in adults but has its limitations as a useful scale in children. The
Ross grading scale on the other hand has its usefulness in infants for
whom it was designed but it has no use in older children. The Ibadan
heart failure grading scale (IHFGS), applicable in children (aged 1
day – 12 years) derived from bedside-elicitable parameters without
the use of sophisticated tools has been designed. The severity grading
scale needs to undergo validation studies involving the use of known
‘gold standards’.
Methods:
A clinical team using the IHFGS, an echocardiographic
team using 2D and M-mode derived standard parameters, and a
clinical chemistry team measuring plasma BNP levels evaluated
100 consecutively recruited children aged one to 120 months with a
clinical diagnosis of congestive heart failure from a variety of causes,
along with 100 age- and gender-matched apparently healthy controls.
Each team, blinded to the findings of other teams and separate from
the primary care team, evaluated each child within half an hour of
the others at presentation. Findings were compared between study
subjects and those of the controls. Specificity and sensitivity of the
IHFGS were determined. Correlation coefficients were determined
between the IHFGS scores and the echocardiographic parameters
and plasma BNP levels, correcting for age and body surface area and
other confounding variables.
Results:
Causes of heart failure included acute respiratory infec-
tions (35%), severe anaemia (30%), congenital heart disease (25%)
and dilated cardiomyopathy (10%). High coefficient of correlation
(+0.85) between IHFGS and plasma BNP levels and echocardio-
graphic parameters were recorded. High specificity and sensitivity
were recorded in respect of the IHFGS definition of no HF, and the
three grades of HF.
Conclusion:
The IHFGS is proposed for use in grading severity of
heart failure in children, especially where sophisticated facilities are
lacking.
1837: CO-ORDINATING CARE FOR LONG-TERM POSTOP-
ERATIVE PICU CARDIAC PATIENTS
Kristy Dea
PICU, Royal Children’s Hospital, Melbourne, Australia
Introduction:
Cardiac patients in the PICU at the Royal Children’s
Hospital (RCH), Melbourne, account for approximately 50% of
bed occupancy. Of these patients, more than 50% have a length of
stay (LOS) longer than seven days. The PICU care manager’s role
is a nursing position introduced in 2008 to provide co-ordination
and consistency in communication and care for all long-term and
complex PICU patients. The following case study of a complex
postoperative cardiac patient provides an example of how the role
supports the complex care needs of a patient during the PICU admis-
sion.
Methods:
A 13-year-old with a past history of tetralogy of Fallot
(TOF) and Alagille syndrome presented to the PICU post right and
left pulmonary artery plasty and redo of RV-to-PA conduit, during
which a left main bronchial injury was sustained intra-operatively.
Surgical complications and projected prolonged ICU stay led to
inclusion as a care managed patient. Support to enable consistent
and co-ordinated care is tailored to specific patient needs according
to age of the patient, surgical pathway, illness acuity, social situa-
tion and postoperative complications. A close working relationship
with all members of the multidisciplinary team, including medical,
nursing and allied health, along with pre-established professional
relationships and processes, enable the PICU care manager to be a
link between patient and family and the hospital team.
Results:
Consistent communication was maintained with weekly
minuted multidisciplinary team meetings; detailed daily and weekly
bedside care plans, and daily booked interpreter sessions (as English
was a second language). Complex care needs were met with regular
bedside support, including care plans for allied health sessions,
ventilation weaning, analgesia and sedation weaning, mental health
management and inotrope rotation management. Bedsides education,
designated nursing care teams and the provision of clinical support
were all instigated for ongoing nursing consistency of care.
Conclusion:
Care co-ordination instigated and supported by a
singular service for complex and long-term PICU patients at RCH
provides a consistent and focal service for holistic and thorough
patient management. The role enables a singular service provider
overview of the patient to improve patient-centred care and to provide
the ongoing perspective for all teams (which are often varied due to
shift structure) to utilise.
