TY  - CHAP
M1  - Book, Section
TI  - Chapter 79. Postoperative Care of the Noncardiac Surgical Intensive Care Unit Patient
A1  - Banks, Michael C.
A1  - Hanson III, C. William
A2  - Longnecker, David E.
A2  - Brown, David L.
A2  - Newman, Mark F.
A2  - Zapol, Warren M.
PY  - 2012
T2  - Anesthesiology, 2e
AB  - 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.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.Critical  illness  polyneuropathy  and  myopathy  are  acute  illnesses  that  result  in  prolonged  weakness  or  paralysis  in  subsets  of  intensive  care  patients.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.Pulmonary  artery  catheter  (PAC)  guided  therapy  has  not  been  shown  to  improve  outcomes  in  critically  ill  patients  with  acute  lung  injury.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).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.  
SN  - 
PB  - The McGraw-Hill Companies
CY  - New York, NY
Y2  - 2024/04/18
UR  - accessanesthesiology.mhmedical.com/content.aspx?aid=56653649
ER  -