Critical Matters Adult congenital disease in the ICU
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Feb 27, 2025 Dr. Cameron Dezfulian, a pediatric and adult critical care physician at Texas Children's Hospital, delves into the complexities of managing adults with congenital heart disease in intensive care. He discusses the unique challenges these patients face, including chronic conditions and the need for specialized care transitions. The conversation also highlights the intricacies of airway management in congenital anomalies and the critical role of multidisciplinary collaboration and effective communication for optimal patient outcomes.
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Modify CT Technique For Fontan Physiology
- Alter CT angiography technique for Fontan patients to avoid false-positive PEs.
- Use delayed-phase imaging or simultaneous upper and lower extremity contrast boluses to get true pulmonary flow distribution.
Know Each Patient's Baseline SpO2
- Many adult congenital patients have chronically low baseline saturations due to shunts or collaterals, so 'low' SpO2 may be normal for them.
- Treating to normal adult saturations can harm rather than help these patients.
Be Cautious With Fluid Resuscitation
- Give fluids cautiously because chronic right-sided volume overload and pulmonary hypertension make these patients prone to acute RV failure.
- Watch for congestive hepatic injury and lymphatic complications like chylothorax or plastic bronchitis after fluid loading.
