Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care cung cấp cho các bạn kiến thức về ngành y đề tài: Clinical review: How to optimize management of high-risk surgical patients. | Available online http content 8 6 503 Review Clinical review How to optimize management of high-risk surgical patients Rupert M Pearse1 Andrew Rhodes2 and R Michael Grounds3 Specialist Registrar in Intensive Care St George s Hospital London UK 2Consultant in Anaesthesia and Intensive Care St George s Hospital London UK 3Reader in Anaesthesia and Intensive Care Medicine St George s Hospital London UK Corresponding author Rupert Pearse Published online 6 August 2004 This article is online at http content 8 6 503 2004 BioMed Central Ltd Critical Care 2004 8 503-507 DOI cc2922 Abstract For many patients optimal perioperative care may require little or no additional medical management beyond that given by the anaesthetist and surgeon. However the continued existence of a group of surgical patients at high risk for morbidity and mortality indicates an ongoing need to identify such patients and deliver optimal care throughout the perioperative period. A group of patients exists in whom the risk for death and serious complications after major surgery is in excess of 20 . The risk is related mainly to the patient s preoperative physiological condition and in particular the cardiovascular and respiratory reserves. Cardiovascular management of the high-risk surgical patient is of particular importance. Once the medical management of underlying disease has been optimized two principal areas remain the use of haemodynamic goals to guide fluid and inotropic therapy and perioperative p blockade. A number of studies have shown that the use of goal-directed haemodynamic therapy during the perioperative period can result in large reductions in morbidity and mortality. Some patients may also benefit from perioperative p blockade which in selected patients has also been shown to result in significant mortality reductions. In this review a pragmatic approach to perioperative management is described giving guidance on the .
