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Postoperative Intensive Care Unit Management After Ruptured Abdominal Aortic Aneurysm

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Ruptured Abdominal Aortic Aneurysm

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Abstract

Management of the patient with a ruptured abdominal aortic aneurysm (rAAA) is arguably the most challenging emergency in vascular surgery and requires rapid and complex decision-making starting from the time of arrival and continuing throughout the ICU stay. Immediate initiation of care based on modern and evidence-based critical care principles is often the deciding factor between a live postoperative patient and a death in the ER or OR. Intensive care unit (ICU) management after surgical repair of the rAAA is a complex undertaking and requires close coordination and cooperation between multiple providers and services, but most importantly the intensivist and the vascular surgeon. The initial ICU period is usually focused on continuing the resuscitation started in the OR and optimizing the patient’s physiology based on the degree of insult, the current status, and function of critical organ systems, with consideration of the multiple preexisting comorbid conditions that typically are present in this patient population. This chapter focuses on the optimal ICU resuscitation and stabilization strategies, timely recognition and treatment of the most common complications, and a system-based strategy for delivery of high-quality, evidence-based, and experience-proven ICU care. Finally, this should all occur within an overarching framework of salvaging not just a survivor but a functional patient who can return to a meaningful level of activity, cognition, and quality of life.

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Authors and Affiliations

  1. Department of Surgery, Madigan Army Medical Center, Tacoma, WA, USA

    John Kuckelman DO & Matthew J. Martin MD, FACS

  2. Department of Internal Medicine, Madigan Army Medical Center, Tacoma, WA, USA

    Alexander Niven MD

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  1. John Kuckelman DO
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  2. Alexander Niven MD
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Correspondence to Matthew J. Martin MD, FACS .

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  1. Division of Vascular Surgery, University of Washington Harborview Medical Center, Seattle, Washington, USA

    Benjamin W. Starnes

  2. Albany Medical Center, Albany, New York, USA

    Manish Mehta

  3. Bronx, New York, USA

    Frank J. Veith

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Kuckelman, J., Niven, A., Martin, M.J. (2017). Postoperative Intensive Care Unit Management After Ruptured Abdominal Aortic Aneurysm. In: Starnes, B., Mehta, M., Veith, F. (eds) Ruptured Abdominal Aortic Aneurysm. Springer, Cham. https://doi.org/10.1007/978-3-319-23844-9_15

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