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 2024/10/03 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).