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Perioperative care of the immunocompromised patient

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Abstract

Immunocompromised patients are increasingly common in modern surgical practice. Challenges related to their care include identifying the determinants of increased risk and selecting the appropriate therapy for individual patients. There are multiple and overlapping causes of immunosuppression in surgical patients that make the interpretation of clinical trials difficult. A clear understanding of these mechanisms guides the physician to choose the immunomodulatory agents that can be used for improving current rates of complication and mortality. The best practical approach to immunocompromised patients involves determining who is at risk, aggressive diagnosis, early therapy, and a high index of suspicion for infectious complications.

Résumé

On est de plus en plus souvent amené a opérer des patients immunodéprimés. La prise en charge de tels patients implique d'identifier les facteurs aggravants le risque et de déterminer le traitement le mieux adapté à chaque cas particulier. Chez les patients chirurgicaux, les causes de dépression immunitaire sont multiples et intriquées rendant ainsi difficile l'interprétation des études cliniques. Une bonne compréhension de ces mécanismes devrait permettre l'utilisation à bon escient des immunomodulateurs pour réduire les taux de complications et de mortalité. En pratique la meilleure attitude à avoir en présence d'un patient immunodéprimé est de reconnaître qu'il s'agit d'un sujet à risque, de mettre en oeuvre rapidement tous les moyens nécessaires au diagnostic, de traiter précocément, et de savoir suspecter une complication infectieuse.

Resumen

Los pacientes inmunocomprometidos son de frecuencia creciete en la práctica quirúrgica moderna. Se reconocen desafíos relativos a su atención quirúrgica, los cuales incluyen la indetificación de los factores determinantes de riego aumentado y la selección de la terapia más adecuada para cada paciente en particular. Existen múltiples causas, y algunas se traslapan, de inmunosupresión en el paciente quirúrgico, lo cual dificulta la interpretación de los resultados de ensayos clínicos. Una compresión clara de tales mecanismos puede servir de guía para la utilización de agentes inmunomoduladores en busca de mejorar las tasas de complicaciones y de mortalidad. El mejor aproche práctico del paciente inmunocomprometido involucra la determinación de que pacientes están en riesgo, un diagnóstico agresivo, una terapia precoz y un alto índice de sospecha acerca de complicaciones sépticas.

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  1. Department of Surgery, McGill University, Royal Victoria Hospital, Montreal, Quebec, Canada

    John Yee M.D. & Nicolas V. Christou M.D., Ph.D., F.R.C.S(C), F.A.C.S.

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  2. Nicolas V. Christou M.D., Ph.D., F.R.C.S(C), F.A.C.S.
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Yee, J., Christou, N.V. Perioperative care of the immunocompromised patient. World J. Surg. 17, 207–214 (1993). https://doi.org/10.1007/BF01658928

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