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How to optimize critical care resources in surgical patients

intensive care without physical borders

Pelosi, Paoloa,b; Ball, Lorenzoa,b; Schultz, Marcus J.c,d

Current Opinion in Critical Care: December 2018 - Volume 24 - Issue 6 - p 581–587
doi: 10.1097/MCC.0000000000000557
THE SURGICAL PATIENT: Edited by Karim Asehnoune
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Purpose of review Timely identification of surgery patients at risk of postoperative complications is important to improve the care process, including critical care. This review discusses epidemiology and impact of postoperative complications; prediction scores used to identify surgical patients at risk of complications, and the role of critical care in the postoperative management. It also discusses how critical care may change, with respect to admission to the ICU.

Recent finding Optimization of postoperative outcome, next to preoperative and intraoperative optimization, consists of using risk scores to early identify patients at risk of developing complications. Critical care consultancy should be performed in the ward after surgery, if necessary. ICUs could work at different levels of intensity, but remain preferably multidisciplinary, combining care for surgical and medical patients. ICU admission should still be considered for those patients at very high risk of postoperative complications, and for those receiving complex or emergency interventions.

Summary To optimize critical care resources for surgery patients at high risk of postoperative complications, the care process should not only include critical care and monitoring in ICUs, but also strict monitoring in the ward. Prediction scores could help to timely identify patients at risk. More intense care (monitoring) outside the ICU could improve outcome. This concept of critical care without borders could be implemented in the near future to optimize the local resources and improve patient safety. Predict more, do less in ICUs, and more in the ward.

aAnaesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology

bDepartment of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy

cDepartment of Intensive Care, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands

dMahidol Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand

Correspondence to Paolo Pelosi, MD, FERS, Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy; IRCCS Policlinico San Martino, Largo Rosanna Benzi 8, 16131 Genoa, Italy. Tel: +39 335 5941740; e-mail: ppelosi@hotmail.com

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