Management and treatment in hospital

Management and treatment in hospital


Stages of Acute Heart Failure Management

Stages of AHF

NOTE: Ensure that discussions regarding escalation measures with ITU/renal/family and ceiling of care are timely and appropriate

Criteria for critical care admission
  • Need for intubation (or already intubated).
  • Poor response to high FiO2 or to NIV.
  • Signs/symptoms/markers of hypoperfusion: cold extremities, altered mentation, confusion, oliguria, lactate >2 mmoUL
  • Persistent hypotension (SBP <90 mmHg).
  • Requirement for two or more vasoactive agents to maintain blood pressure.
  • Requirement for invasive cardiac output monitoring.
  • Requirement for MCS.
  • Heart rate <40 b.p.m. or persistent life-threatening arrhythmia.
  • Any associated non-cardiac condition requiring critical care admission (e.g. continuous venovenous hemodiafiltration and ultrafltration).
Criteria for intubation
  • Cardiac or respiratory arrest
  • Progressive worsening of altered mental status
  • Progressive worsening of respiratory failure with hypoxaemia [Pa02 <60 mmHg (8.0 kPa)], hypercapnia [PaCO2 >50 mmHg (6.65 kPa)] and acidosis (pH<7.35), despite NIV
  • Need of airway protection
  • Persistent haemodynamic instability
  • Agitation or intolerance to NIV with progressive respiratory failure

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(c) British Society for Heart Failure, 2022-
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