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Surgical Procedures in the Intensive Care Unit

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Abstract

The operating room is the preferred location for surgeons to perform procedures. The sterile environment, trained and experienced support staff, readily available equipment, and superior lighting make it a desired location for surgeons. However, in many situations the intensive care unit (ICU) may offer advantages as a procedural location, and many procedures that are usually performed in a dedicated environment can safely be performed in the ICU. The focus of this chapter is on those procedures that are often required of the acute care surgeon in the ICU.

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References

  1. British Thoracic Society Bronchoscopy Guidelines Committee, a Subcommittee Standards of Care Committee of British Thoracic Society. British Thoracic Society guidelines on diagnostic flexible bronchoscopy. Thorax. 2001;56 Suppl 1:i1–21.

    Google Scholar 

  2. Prakash UB. Advances in bronchoscopic procedures. Chest. 1999;116(5):1403–8.

    Article  CAS  PubMed  Google Scholar 

  3. Vejdan AK, Khosravi M. BAL for pneumonia prevention in tracheostomy patients: a clinical trial study. Pak J Med Sci. 2013;29(1):148–51.

    Google Scholar 

  4. Lee HW, Min J, et al. Clinical impact of early bronchoscopy in mechanically ventilated patients with aspiration pneumonia. Respirology. 2015;20(7):1115–22.

    Article  PubMed  Google Scholar 

  5. Pue CA, Pacht ER. Complications of fiberoptic bronchoscopy at a university hospital. Chest. 1995;107(2):430–2.

    Article  CAS  PubMed  Google Scholar 

  6. Jackson C. Tracheotomy. Laryngoscope. 1909;19:285–90.

    Google Scholar 

  7. Ciaglia P, Firsching R, Syniec C. Elective percutaneous dilatational tracheostomy. A new simple bedside procedure; preliminary report. Chest. 1985;87(6):715–9.

    Article  CAS  PubMed  Google Scholar 

  8. Lim CK, Ruan SY, Lin FC, et al. Effect of tracheostomy on weaning parameters in difficult-to-wean mechanically ventilated patients: a prospective observational study. PLoS One. 2015;10(9)

    Google Scholar 

  9. Yoo DB, Schiff BA, Martz S, et al. Open bedside tracheotomy: impact on patient care and patient safety. Laryngoscope. 2011;121(3):515–20.

    Article  PubMed  Google Scholar 

  10. Massick DD, Yao S, Powell DM, et al. Bedside tracheostomy in the intensive care unit: a prospective randomized trial comparing open surgical tracheostomy with endoscopically guided percutaneous dilational tracheotomy. Laryngoscope. 2001;111(3):494–500.

    Article  CAS  PubMed  Google Scholar 

  11. McHenry CR, Raeburn CD, Lange RL, Priebe PP. Percutaneous tracheostomy: a cost-effective alternative to standard open tracheostomy. Am Surg. 1997;63(7):646–51.

    CAS  PubMed  Google Scholar 

  12. Hill BB, Zweng TN, Maley RH, Charash WE, Toursarkissian B, Kearney PA. Percutaneous dilational tracheostomy: report of 356 cases. J Trauma. 1996;41(2):238–43.

    Article  CAS  PubMed  Google Scholar 

  13. Futran ND, Dutcher PO, Roberts JK. The safety and efficacy of bedside tracheotomy. Otolaryngol Head Neck Surg. 1993;109(4):707–11.

    CAS  PubMed  Google Scholar 

  14. Upadhyay A, Maurer J, Turner J, Tiszenkel H, Rosengart T. Elective bedside tracheostomy in the intensive care unit. J Am Coll Surg. 1996;183(1):51–5.

    CAS  PubMed  Google Scholar 

  15. Wang SJ, Sercarz JA, Blackwell KE, Aghamohammadi M, Wang MB. Open bedside tracheotomy in the intensive care unit. Laryngoscope. 1999;109(6):891–3.

    Article  CAS  PubMed  Google Scholar 

  16. Silvester W, Goldsmith D, Uchino S, et al. Percutaneous versus surgical tracheostomy: a randomized controlled study with long-term follow-up. Crit Care Med. 2006;34(8):2145–52.

    Article  PubMed  Google Scholar 

  17. Gysin C, Dulguerov P, Guyot JP, Perneger TV, Abajo B, Chevrolet JC. Percutaneous versus surgical tracheostomy: a double-blind randomized trial. Ann Surg. 1999;230(5):708–14.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Bowen CP, Whitney LR, Truwit JD, Durbin CG, Moore MM. Comparison of safety and cost of percutaneous versus surgical tracheostomy. Am Surg. 2001;67(1):54–60.

    CAS  PubMed  Google Scholar 

  19. Porter JM, Ivatury RR. Preferred route of tracheostomy—percutaneous versus open at the bedside: a randomized, prospective study in the surgical intensive care unit. Am Surg. 1999;65(2):142–6.

    CAS  PubMed  Google Scholar 

  20. Kuechler JN, Abusamha A, Ziemann S, et al. Impact of percutaneous dilatational tracheostomy in brain injured patients. Clin Neurol Neurosurg. 2015;137:137–41.

    Article  PubMed  Google Scholar 

  21. Yaghoobi S, Kayalha H, Ghafouri R, et al. Comparison of complications in percutaneous dilatational tracheostomy versus surgical tracheostomy. Glob J Health Sci. 2014;6(4):221–5.

    PubMed  PubMed Central  Google Scholar 

  22. Mittendorf EA, McHenry CR, Smith CM, Yowler CJ, Peerless JR. Early and late outcome of bedside percutaneous tracheostomy in the intensive care unit. Am Surg. 2002;68(4):342–6. Discussion 346–347.

    PubMed  Google Scholar 

  23. Kornblith LZ, Burlew CC, Moore EE, et al. One thousand bedside percutaneous tracheostomies in the surgical intensive care unit: time to change the gold standard. J Am Coll Surg. 2011;212(2):163–70.

    Article  PubMed  Google Scholar 

  24. Vargas M, Sutherasa Y, et al. Tracheostomy procedures in the intensive care unit: an international survey. Crit Care. 2015;19:291.

    Google Scholar 

  25. Hazelton JP, Orfe EC, Colacino AM, et al. The impact of multidisciplinary safety checklist on adverse procedural events during bedside bronchoscopy-guided percutaneous tracheostomy. J Trauma Acute Care Surg. 2015;79(1):111–5.

    Article  PubMed  Google Scholar 

  26. Laws D, Neville E, Duffy J. BTS guidelines for the insertion of a chest drain. Thorax. 2003;58 Suppl 2:ii53–9.

    Google Scholar 

  27. Russo RM, Zakaluzny SA, Neff LP, et al. A pilot study of chest tube versus pigtail catheter drainage of acute hemothorax in swine. J Trauma Acute Care Surg. 2015;79(6):1038–43.

    Article  PubMed  Google Scholar 

  28. Deutsch E, Beck S, et al. Ultrasound guided chest tube placement for basilar pneumothorax. Intern Emerg Med. 2015.

    Google Scholar 

  29. Wilkerson RG, Stone MB. Sensitivity of bedside ultrasound and supine anteroposterior chest radiographs for the identification of pneumothorax after blunt trauma. Acad Emerg Med. 2010;17(1):11–7.

    Article  PubMed  Google Scholar 

  30. Sethuraman KN, Duong D, et al. Complications of tube thoracostomy placement in the emergency department. J Emerg Med. 2011;40(1):14–20.

    Article  PubMed  Google Scholar 

  31. Lee A, Lau TN, Yeong KY. Indwelling catheters for the management of malignant ascites. Support Care Cancer. 2000;8(6):493–9.

    CAS  PubMed  Google Scholar 

  32. De Gottardi A, Thevenot T, Spahr L, et al. Risk of complications after abdominal paracentesis in cirrhotic patients: a prospective study. Clin Gastroenterol Hepatol. 2009;7:906.

    Article  PubMed  Google Scholar 

  33. Grabau CM, Crago SF, Hoff LK, et al. Performance standards for therapeutic abdominal paracentesis. Hepatology. 2004;40:484.

    Article  PubMed  Google Scholar 

  34. McVay PA, Toy PTCY. Lack of increased bleeding after paracentesis and thoracentesis in patients with mild coagulation abnormalities. Transfusion. 1991;31:164.

    Article  CAS  PubMed  Google Scholar 

  35. Pache I, Bilodeau M. Severe haemorrhage following abdominal paracentesis for ascites in patients with liver disease. Aliment Pharmacol Ther. 2005;21:525.

    Article  CAS  PubMed  Google Scholar 

  36. Runyon BA, Canawati HN, Akriviadis EA. Optimization of ascitic fluid culture technique. Gastroenterology. 1988;95:1351.

    Article  CAS  PubMed  Google Scholar 

  37. Runyon BA. Paracentesis of ascetic fluid; a safe procedure. Arch Intern Med. 1986;146:2259.

    Article  CAS  PubMed  Google Scholar 

  38. Rogers FB, Shackford SR, Ricci MA, et al. Routine prophylactic vena cava filter insertion in severely injured trauma patients decreases the incidence of pulmonary embolism. J Am Coll Surg. 1995;180(6):641–7.

    CAS  PubMed  Google Scholar 

  39. Caplin DM, Nikolic B, Kalva SP, et al. Quality improvement guidelines for the performance of inferior vena cava filter placement for the prevention of pulmonary embolism. J Vasc Interv Radiol. 2011;22:1499.

    PubMed  Google Scholar 

  40. Hemmila MR, Osborne NH, Henke PK, et al. Prophylactic inferior vena cava filter placement does not result in a survival benefit for trauma patients. Ann Surg. 2015;262(4):577–85.

    Article  PubMed  Google Scholar 

  41. Ashley DW, Gamblin TC, McCampbell BL, et al. Bedside insertion of vena cava filters in the intensive care unit using intravascular ultrasound to locate renal veins. J Trauma. 2004;57(1):26–31.

    Article  PubMed  Google Scholar 

  42. Mismetti P, Laporte S, Pellerin O, et al. Effect of retrievable inferior vena cava filter plus anticoagulation vs anticoagulation alone on risk of recurrent pulmonary embolism: a randomized clinical trial. JAMA. 2015;313(16):1627–35.

    Article  PubMed  Google Scholar 

  43. Hernandez G, Velasco N, Wainstein C, et al. Gut mucosal atrophy after a short enteral fasting period in critically ill patients. J Crit Care. 1999;14(2):73–7.

    Article  CAS  PubMed  Google Scholar 

  44. Rafferty GP, Tham TC. Endoscopic placement of enteral feeding tubes. World J Gastrointest Endosc. 2010;2(5):155–64.

    PubMed  PubMed Central  Google Scholar 

  45. Kortbeek JB, Haigh PI, Doig C. Duodenal versus gastric feeding in ventilated blunt trauma patients: a randomized controlled trial. J Trauma. 1999;46:992–6.

    Article  CAS  PubMed  Google Scholar 

  46. Heyland DK, Drover JW, MacDonald S, et al. Effect of postpyloric feeding on gastroesophageal regurgitation and pulmonary microaspiration: results of a randomized controlled trial. Crit Care Med. 2001;29:1495–500.

    Article  CAS  PubMed  Google Scholar 

  47. Tournadre JP, Barclay M, Fraser R, et al. Small intestinal motor patterns in critically ill patients after major abdominal surgery. Am J Gastroenterol. 2001;96:2418–26.

    Article  Google Scholar 

  48. Heyland DK, Dhaliwal R, Drover JW, et al. Canadian clinical practice guidelines for nutrition support in mechanically ventilated, critically ill adult patients. JPEN J Parenter Enteral Nutr. 2003;27:355–73.

    Article  PubMed  Google Scholar 

  49. Nicholson FB, Korman MG, Richardson MA. Percutaneous endoscopic gastrostomy: a review of indications, complications and outcome. J Gastroenterol Hepatol. 2000;15(1):21–5.

    Article  CAS  PubMed  Google Scholar 

  50. Tham TC, Taitelbaum G, Carr-Locke DL. Percutaneous endoscopic gastrostomies: are they being done for the right reasons? QJM. 1997;90(8):495–6.

    Article  CAS  PubMed  Google Scholar 

  51. Skelly RH, Kupfer RM, Metcalfe ME, et al. Percutaneous endoscopic gastrostomy (PEG): change in practice since 1988. Clin Nutr. 2002;21(5):389–94.

    Article  CAS  PubMed  Google Scholar 

  52. Akkersdijk WL, van Bergeijk JD, van Egmond T, et al. Percutaneous endoscopic gastrostomy (PEG): comparison of push and pull methods and evaluation of antibiotic prophylaxis. Endoscopy. 1995;27(4):313–6.

    Article  CAS  PubMed  Google Scholar 

  53. Shastri YM, Hoepffner N, Tessmer A, Ackermann H, Schroeder O, Stein J. New introducer PEG gastropexy does not require prophylactic antibiotics: multicenter prospective randomized double-blind placebo-controlled study. Gastrointest Endosc. 2008;67(4):620–8.

    Article  PubMed  Google Scholar 

  54. Dormann AJ, Wejda B, Kahl S, Huchzermeyer H, Ebert MP, Malfertheiner P. Long-term results with a new introducer method with gastropexy for percutaneous endoscopic gastrostomy. Am J Gastroenterol. 2006;101(6):1229–34.

    Article  PubMed  Google Scholar 

  55. Maetani I, Tada T, Ukita T, Inoue H, Sakai Y, Yoshikawa M. PEG with introducer or pull method: a prospective randomized comparison. Gastrointest Endosc. 2003;57(7):837–41.

    Article  PubMed  Google Scholar 

  56. Tucker AT, Gourin CG, Ghegan MD, Porubsky ES, Martindale RG, Terris DJ. ‘Push’ versus ‘pull’ percutaneous endoscopic gastrostomy tube placement in patients with advanced head and neck cancer. Laryngoscope. 2003;113(11):1898–902.

    Article  PubMed  Google Scholar 

  57. Bai Y, Guo JF, Li ZS. Meta-analysis: erythromycin before endoscopy for acute upper gastrointestinal bleeding. Aliment Pharmacol Ther. 2011;34(2):166–71.

    Article  CAS  PubMed  Google Scholar 

  58. Barkun AN, Bardou M, Kuipers EJ, et al. International consensus recommendations on the management of patients with nonvariceal upper gastrointestinal bleeding. Ann Intern Med. 2010;152(2):101–13.

    Article  PubMed  Google Scholar 

  59. Mirsadraee S, Tirukonda P, Nicholson A, Everett SM, McPherson SJ. Embolization for non-variceal upper gastrointestinal tract haemorrhage: a systematic review. Clin Radiol. 2011;66(6):500–9.

    Article  CAS  PubMed  Google Scholar 

  60. Sung JJ, Tsoi KK, Lai LH, Wu JC, Lau JY. Endoscopic clipping versus injection and thermo-coagulation in the treatment of non-variceal upper gastrointestinal bleeding: a meta-analysis. Gut. 2007;56(10):1364–73.

    Article  PubMed  PubMed Central  Google Scholar 

  61. Garcia-Tsao G, Sanyal AJ, Grace ND, Carey WD. Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis. Am J Gastroenterol. 2007;102(9):2086–102.

    Article  PubMed  Google Scholar 

  62. Corley DA, Cello JP, Adkisson W, Ko WF, Kerlikowske K. Octreotide for acute esophageal variceal bleeding: a meta-analysis. Gastroenterology. 2001;120(4):946–54.

    Article  CAS  PubMed  Google Scholar 

  63. D’Amico G, Pagliaro L, Pietrosi G, Tarantino I. Emergency sclerotherapy versus vasoactive drugs for bleeding oesophageal varices in cirrhotic patients. Cochrane Database Syst Rev. 2010;3, CD002233.

    Google Scholar 

  64. Chen WC, Lo GH, Tsai WL, Hsu PI, Lin CK, Lai KH. Emergency endoscopic variceal ligation versus somatostatin for acute esophageal variceal bleeding. J Chin Med Assoc. 2006;69(2):60–7.

    Article  PubMed  Google Scholar 

  65. Banares R, Albillos A, Rincon D, et al. Endoscopic treatment versus endoscopic plus pharmacologic treatment for acute variceal bleeding: a meta-analysis. Hepatology. 2002;35(3):609–15.

    Article  PubMed  Google Scholar 

  66. Lo GH. Management of acute esophageal variceal hemorrhage. Kaohsiung J Med Sci. 2010;26(2):55–67.

    Article  CAS  PubMed  Google Scholar 

  67. Haddock G, Garden OJ, McKee RF, Anderson JR, Carter DC. Esophageal tamponade in the management of acute variceal hemorrhage. Dig Dis Sci. 1989;34(6):913–8.

    Article  CAS  PubMed  Google Scholar 

  68. Garcia-Iglesias P, Villoria A, Suarez D, et al. Meta-analysis: predictors of rebleeding after endoscopic treatment for bleeding peptic ulcer. Aliment Pharmacol Ther. 2011;34(8):888–900.

    Article  CAS  PubMed  Google Scholar 

  69. Marmo R, Koch M, Cipolletta L, et al. Predicting mortality in non-variceal upper gastrointestinal bleeders: validation of the Italian PNED Score and Prospective Comparison with the Rockall Score. Am J Gastroenterol. 2010;105(6):1284–91.

    Article  PubMed  Google Scholar 

  70. Chiu PW, Ng EK, Cheung FK, et al. Predicting mortality in patients with bleeding peptic ulcers after therapeutic endoscopy. Clin Gastroenterol Hepatol. 2009;7(3):311–6. Quiz 253.

    Article  PubMed  Google Scholar 

  71. Sreedharan A, Martin J, Leontiadis GI, et al. Proton pump inhibitor treatment initiated prior to endoscopic diagnosis in upper gastrointestinal bleeding. Cochrane Database Syst Rev. 2010;7, CD005415.

    Google Scholar 

  72. Hidaka H, Nakazawa T, Wang G, et al. Long-term administration of PPI reduces treatment failures after esophageal variceal band ligation: a randomized, controlled trial. J Gastroenterol. 2012;47(2):118–26.

    Article  CAS  PubMed  Google Scholar 

  73. Funakoshi N, Segalas-Largey F, Duny Y, et al. Benefit of combination beta-blocker and endoscopic treatment to prevent variceal rebleeding: a meta-analysis. World J Gastroenterol. 2010;16(47):5982–92.

    PubMed  PubMed Central  Google Scholar 

  74. Hendrickson RJ, Diaz AA, Salloum R, Koniaris LG. Benign rectal ulcer: an underground cause of inpatient lower gastrointestinal bleeding. Surg Endosc. 2003;17(11):1759–65.

    Article  CAS  PubMed  Google Scholar 

  75. Farrell JJ, Friedman LS. Gastrointestinal bleeding in the elderly. Gastroenterol Clin North Am. 2001;30(2):377–407, viii.

    Google Scholar 

  76. Bounds BC, Friedman LS. Lower gastrointestinal bleeding. Gastroenterol Clin North Am. 2003;32(4):1107–25.

    Article  PubMed  Google Scholar 

  77. Schuetz A, Jauch KW. Lower gastrointestinal bleeding: therapeutic strategies, surgical techniques and results. Langenbecks Arch Surg. 2001;386(1):17–25.

    Article  CAS  PubMed  Google Scholar 

  78. Zuckerman GR, Prakash C. Acute lower intestinal bleeding. Part II: Etiology, therapy, and outcomes. Gastrointest Endosc. 1999;49(2):228–38.

    Article  CAS  PubMed  Google Scholar 

  79. Wong SK, Ho YH, Leong AP, Seow-Choen F. Clinical behavior of complicated right-sided and left-sided diverticulosis. Dis Colon Rectum. 1997;40(3):344–8.

    Article  CAS  PubMed  Google Scholar 

  80. Chen CY, Wu CC, Jao SW, Pai L, Hsiao CW. Colonic diverticular bleeding with comorbid diseases may need elective colectomy. J Gastrointest Surg. 2009;13(3):516–20.

    Article  PubMed  Google Scholar 

  81. Jensen DM. Diagnosis and treatment of patients with severe hematochezia: a time for change. Endoscopy. 1998;30(8):724–6.

    Article  CAS  PubMed  Google Scholar 

  82. Foutch PG, Zimmerman K. Diverticular bleeding and the pigmented protuberance (sentinel clot): clinical implications, histopathological correlation, and results of endoscopic intervention. Am J Gastroenterol. 1996;91(12):2589–93.

    CAS  PubMed  Google Scholar 

  83. Binmoeller KF, Thonke F, Soehendra N. Endoscopic hemoclip treatment for gastrointestinal bleeding. Endoscopy. 1993;25(2):167–70.

    Article  CAS  PubMed  Google Scholar 

  84. Khanna A, Ognibene SJ, Koniaris LG. Embolization as first-line therapy for diverticulosis-related massive lower gastrointestinal bleeding: evidence from a meta-analysis. J Gastrointest Surg. 2005;9(3):343–52.

    Article  PubMed  Google Scholar 

  85. Vernava 3rd AM, Moore BA, Longo WE, Johnson FE. Lower gastrointestinal bleeding. Dis Colon Rectum. 1997;40(7):846–58.

    Article  PubMed  Google Scholar 

  86. Schreiber J, Nierhaus A, Vettorazzi E, et al. Rescue bedside laparotomy in the intensive care unit in patients too unstable for transport to the operating room. Crit Care. 2014;18:R123.

    Article  PubMed  PubMed Central  Google Scholar 

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Sonnaike, E., Ward, J.L. (2017). Surgical Procedures in the Intensive Care Unit. In: Moore, L., Todd, S. (eds) Common Problems in Acute Care Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-42792-8_5

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