Hemodynamic Effects of Bathing in the Pediatric Cardiac Intensive Care Unit

RESEARCHPurpose: Neonates and infants in a pediatric cardiac intensive care unit (CICU) are particularly susceptible to hemodynamic consequences of environmental exposure, agitation, and increased systemic vascular resistance associated with bathing. Clinical observations have generated significant debate regarding the physiologic changes that may occur related to patient bathing, leading to modified care practices surrounding routine bathing in the CICU. Due to the paucity of evidence surrounding physiologic changes associated with bathing in the CICU, we aim to describe the vital sign and hemodynamic profile of this high risk neonatal and infant population undergoing routine bathing in a pediatric CICU.
Methods: A prospective time series descriptive analysis of infants
Results: Twenty-two patients underwent 164 bath events over 4 weeks. Median age at each bath was 53 [11-155] days and median duration was 12 min [IQR 9-17 min]. Majority of baths occurred post-operatively (67%, n=110), in the evening (4PM - 11PM, 70%, n=115), and via non-immersion water/soap technique (58% n=96). Only 35% (n=57) of baths were in mechanically ventilated patients and 24% (n=39) were in single ventricle patients. No cardiac arrests were observed although bedside care escalations occurred in 38% (n=66) of events. Significant increases in HR (8.17 ± 1.81), mABP (4.91 mmHg ± 1.46 mmHg; p