RT Book, Section
A1 Rock, Kristen Carey
A1 Hanson, III, C. William
A2 Longnecker, David E.
A2 Mackey, Sean C.
A2 Newman, Mark F.
A2 Sandberg, Warren S.
A2 Zapol, Warren M.
SR Print(0)
ID 1144135314
T1 Postoperative Care of the Surgical ICU Patient
T2 Anesthesiology, 3e
YR 2017
FD 2017
PB McGraw-Hill Education
PP New York, NY
SN 9780071848817
LK accessanesthesiology.mhmedical.com/content.aspx?aid=1144135314
RD 2024/04/19
AB KEY  POINTSDemand  is  growing  for  postoperative  intensive  care  services  due  to  changing  surgical  techniques  and  the  aging  of  the  population.  Because  of  advances  in  minimally  invasive  surgery,  improved  anesthetic  techniques  and  options  for  post-operative  analgesia,  the  critically  ill  patient  population  has  changed.Anesthesiologists  and  surgical  intensivists  play  a  major  role  in  ensuring  responsible  use  of  this  costly  resource.Critically  ill  patients  are  at  risk  for  a  variety  of  pulmonary  complications,  including  aspiration,  ventilator-associated  pneumonia,  and  acute  lung  injury.  Intensive  care  management  is  directed  at  minimizing  the  risk  factors  predisposing  patients  to  these  complications.The  concept  of  chronic  critical  illness  has  become  more  adequately  characterized  as  a  state  of  anergy,  immunosuppression,  chronic  multiorgan  system  dysfunction,  cognitive  dysfunction,  and  critical  illness  polyneuropathy  and  myopathy  that  is  difficult  to  reverse  and  carries  a  high  morbidity  and  mortality.Advanced  monitoring  devices  such  as  noninvasive  ICP  monitors,  cerebral  oximeters,  BIS  monitors,  continuous  TEE  (transesophageal  echo),  noninvasive  cardiac  output  monitors,  and  continuous  end-tidal  CO2  (carbon  dioxide)  assist  the  intensivist  in  complex  decision  making.Conservative  fluid  management  results  in  improved  lung  function  and  shortens  the  duration  of  both  mechanical  ventilation  and  intensive  care  stay  without  altering  the  rate  of  extrapulmonary  organ  failure.The  stress  response  after  major  surgery  or  injury  is  often  accompanied  by  a  period  of  endothelial  cell  dysfunction  and  capillary  leak  with  loss  of  plasma  volume  into  the  extracellular  third  space.  The  stress  response  may  be  initiated  by  tissue  hypoperfusion  due  to  inadequate  fluid  resuscitation,  ischemia-reperfusion  injury,  cytokine  release,  or  exposure  of  the  circulating  blood  volume  to  an  extracorporeal  circuit  (ie,  blood  salvage  circuits,  cardiopulmonary  bypass).