RT Book, Section A1 Alali, Aziz S. A1 Baker, Andrew J. A1 Ali, Jameel A2 Hall, Jesse B. A2 Schmidt, Gregory A. A2 Kress, John P. SR Print(0) ID 1107712239 T1 Special Considerations in the Surgical Patient T2 Principles of Critical Care, 4e YR 2015 FD 2015 PB McGraw-Hill Education PP New York, NY SN 9780071738811 LK accesssurgery.mhmedical.com/content.aspx?aid=1107712239 RD 2024/03/28 AB The biologic response to surgery results in fluid, electrolyte, and systemic hormonal changes that must be considered in the ICU management of the surgical patient.Nutritional support of the critically ill surgical patient must involve consideration of the effect of surgical stress on nitrogen balance and on insulin and blood glucose levels.The hypercoagulable state that follows surgery warrants consideration of prophylaxis against thromboembolic complications, particularly in the ICU patient.Prompt surgical control of the source of the pathology remains the most important goal in either bleeding or septic critically ill patients.Surgery increases the demand on the cardiorespiratory system and the likelihood that temporary 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 is important in understanding perioperative atelectasis.Risk factors for perioperative atelectasis include obesity, smoking, advanced age, anesthesia, recumbence, 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.