Optimization of the high-risk surgical patient

Abstract

The normal acute physiological response to critical illness is to increase the oxygen delivery and consumption. Normal values are considered abnormal in the context of acute critical illness, and patients who achieve specific supra-normal hemodynamic variables have a better outcome. This forms the basis of optimization as these hemodynamic variables attained by survivors become a therapeutic target that achieved artificially by the use of intravenous fluids and inotropes under the guidance of cardiac output monitoring. This approach has been shown to improve the tissue oxygenation and prevents organ dysfunction and death in the high-risk patients undergoing major surgery.1,2 This chapter focuses on the perioperative optimization and the reader should refer to relevant chapters for the specific management of trauma and sepsis. © 2010 Springer-Verlag US.