ICU Management: Clearing Patients for Surgery

Abstract

The decision-making for patients treated in the ICU is different from the one required in the early stages after trauma, where resuscitation and hemorrhage control represent key factors. Early after injury, the surgical decision mainly serves to separate between surgical requirements and decide if damage control techniques, or a safe definitive surgery can be performed. Also, the main focus within the first 24 h is to respect the four pathogenetic pathways (Shock, Acidosis, Coagulopathy, Soft tissue-induced changes). During the subsequent days, avoiding ICU-related complications is key. This implies to keep ventilation times low and reassessing patients for foci that might cause sepsis, ARDS, and avoid secondary bleeding complications. The parameters to be assessed focus on ongoing positive fluid balances (I/O ratio), failure of blood counts (e.g., platelet counts) to normalize and the inability to wean the patient off the ventilator. While the post trauma days 2–4 were avoided in terms of further major surgeries, the current thinking is that normalized physiology may vary between patients despite similar injury severities. Therefore, the management has become more variable.