The Surgical clinics of North America
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Severe secondary peritonitis carries significant mortality, despite advancements in critical care support and other therapies. Surgical management requires a multidisciplinary approach to guide the timing and the number of interventions necessary to eradicate the septic foci and create optimal healing with the fewest complications. ⋯ These patients have a high risk of anastomotic failure and fistula formation. Allowing for aggressive resuscitation and judicious assessment of the progression of local inflammation are safe strategies to achieve the highest success and minimize serious and protracted complications in patients who survive the initial septic insult.
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Surg. Clin. North Am. · Dec 2006
ReviewThe relationship between the surgeon and the intensivist in the surgical intensive care unit.
When a patient enters the intensive care unit, the admitting surgeon also enters a new environment. In some hospitals, the surgical intensive care unit (SICU) is "closed"--critical care providers manage care; in others the unit is "open," and the admitting surgeon is in charge. ⋯ It is written from the perspective of two surgeon-intensivists who have been in both roles. Recent behavioral and social research on ICU conflicts and their resolution is reviewed, and and new strategies for conflict resolution are also presented.
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Acute respiratory failure is manifested clinically as a patient with variable degrees of respiratory distress, but characteristically an abnormal arterial blood partial pressure of oxygen or carbon dioxide. The application of mechanical ventilation in this setting can be life-saving. ⋯ Clinicians involved with the care of critically ill patients must recognize and seek to prevent these complications using lung-protective ventilation strategies. This article discusses the basic concepts of mechanical ventilation, reviews the categories of ventilator-associated lung injury, and discusses current strategies for the recognition and prevention of these adverse effects in the application of mechanical ventilation.