TY - CHAP M1 - Book, Section TI - Special Considerations in the Surgical Patient A1 - Ali, Jameel A2 - Schmidt, Gregory A. A2 - Kress, John P. A2 - Douglas, Ivor S. PY - 2023 T2 - Hall, Schmidt and Wood’s Principles of Critical Care, 5th Edition AB - KEY POINTSThe systemic response to surgery and trauma results in fluid, electrolyte, and hormonal changes that impact ICU management of the surgical patient.In planning nutritional support, the effect of surgical stress on nitrogen balance and on insulin and blood glucose levels is important.Surgical stress promotes a hypercoagulable state that warrants consideration of prophylaxis against thromboembolism.Prompt identification with control of bleeding and sepsis is crucial for management of these patients.Surgery increases cardiorespiratory demand and the likelihood that mechanical ventilatory assistance will be needed.Pulmonary edema and atelectasis characterize perioperative respiratory failure; hypoventilation and aspiration also contribute.Where possible, a reduction of pulmonary capillary hydrostatic pressure in the perioperative period improves gas exchange by decreasing lung water.The concept of closing volume and its relationship to functional residual capacity (FRC) is important in understanding perioperative atelectasis.Risk factors for perioperative atelectasis include obesity, smoking, advanced age, anesthesia, recumbency, and incisional pain.Diaphragmatic dysfunction is a major component of perioperative respiratory failure.Preoperative assessment of respiratory function makes it possible to predict operative risk and to correct abnormalities before operation, particularly in the patient undergoing lung resection.Early ambulation, physiotherapy, treatment of sepsis and shock, adequate analgesia, and early operative stabilization of fractures are key elements in the treatment and prevention of perioperative respiratory failure. SN - PB - McGraw Hill CY - New York, NY Y2 - 2023/12/09 UR - accessanesthesiology.mhmedical.com/content.aspx?aid=1201810141 ER -