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  1. Demand is growing for postoperative intensive care services due to advances in surgical techniques and the aging of the population. Anesthesiologists and surgical intensivists play a major role in ensuring responsible use of this costly resource.

  2. Advances in neuraxial pain management have revolutionized certain types of surgery (eg, thoracic and major vascular), permitting patients to undergo major procedures without the need for prolonged intensive care following surgery.

  3. Critical illness polyneuropathy and myopathy are acute illnesses that result in prolonged weakness or paralysis in subsets of intensive care patients.

  4. 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.

  5. Pulmonary artery catheter (PAC) guided therapy has not been shown to improve outcomes in critically ill patients with acute lung injury.

  6. 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.

  7. 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).

  8. Renal replacement therapy is a field that has evolved significantly over the past decade, and venovenous diafiltration and hemodialysis have displaced techniques such as arteriovenous hemodialysis.

The surgical intensive care unit (SICU), or a combined medical-surgical ICU, is a specialized patient care floor designed to accommodate and treat critically ill surgical patients in the perioperative period, which may include preoperative, postoperative, and posttrauma injury management. As critical care techniques have evolved, it has become possible to both save the lives of some who might previously have died and prolong the lives of others who will nevertheless still not survive. The percentage of critical care beds has grown in many hospitals, and it is still an increasingly expensive and constrained resource due in part to shortages of qualified physicians, nurses, and ancillary personnel. It is vital, therefore, to find models of efficient and appropriately targeted intensive care.

The types of patients admitted to ICUs have changed considerably over the past several decades. The evolution of trauma systems, with rapid transportation of critically injured patients, has resulted in the concentration of complex multitrauma patients in trauma centers. The evolution of ventricular assist devices, thoracic aortic surgery, and heart and lung transplantation has revolutionized cardiothoracic surgery and changed the nature of perioperative cardiac intensive care. New approaches to the management of head injury and advanced neurosurgical techniques require increased technological sophistication in cerebral monitoring. Advances in the treatment of acute lung injury have resulted from research collaboratives such as the National Institutes of Health ARDS Network ...

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