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DOI: 10.1016/j.medine.2019.03.010
Available online 30 June 2019
Perioperative intensive care medicine
Medicina intensiva perioperatoria
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M.C. Martín Delgadoa,b,
Corresponding author
mcmartindelgad@gmail.com

Corresponding author.
, F. Gordo Vidalc,d
a Servicio Medicina Intensiva, Hospital Universitario de Torrejón, Torrejón de Ardóz, Madrid, Spain
b Grado en Medicina, Universidad Francisco de Vitoria (UFV), Madrid, Spain
c Servicio de Medicina Intensiva, Hospital Universitario del Henares, Coslada, Madrid, Spain
d Grupo de Investigación en Patología Crítica, Universidad Francisco de Vitoria, Madrid, Spain
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Received 18 March 2019. Accepted 24 March 2019
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Table 1. Recommendations for postoperative patient management in the intensive care unit (ICU).
Table 2. Participation of the Department of Intensive Care Medicine in perioperative medical practice.
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Abstract

Surgery represents one of the main therapeutic references in the world, affording greater survival and life expectancy for many patients. In general, the estimated postoperative mortality is low (around 1–4%). Thirteen percent of the surgical procedures have a high risk of complications, accounting for 80% of all postoperative deaths. Recently, there have been significant advances related to organizational aspects, new anesthetic and surgical techniques, prognostic scales, perioperative management and greater participation and involvement of the patient. This new series of Medicina Intensiva will address fundamental aspects of how Departments of Intensive Care Medicine can add value to the surgical process, in a coordinated manner with other services. Institutional policies are required to ensure the detection of patients at risk in hospitalization wards, with early admission to the ICU of those patients in whom admission is indicated, adapting the treatment in the ICU and optimizing the criteria for discharge. The detection and prevention of post-ICU syndrome in patients and relatives, and the follow-up of ICU discharge and hospitalization in a multidisciplinary manner can reduce the sequelae among critical surgical patients, improving the outcomes and quality of life, and restoring the patient to society. In future publications of this series directed to the surgical patient, updates will be provided on the perioperative management of some of the most complex surgeries.

Keywords:
Perioperative intensive care
Intensive care unit
Postoperative
Resumen

La cirugía representa uno de los principales pilares terapéuticos en todo el mundo, ofreciendo una mayor supervivencia y esperanza de vida para muchos pacientes. En general, se estima una mortalidad postoperatoria baja, alrededor del 1-4%. Un 13% de los procedimientos quirúrgicos tienen un riesgo alto de complicaciones, representando un 80% de las muertes postoperatorias. Recientemente, se han producido avances significativos relacionados con aspectos organizativos, nuevas técnicas anestésicas y quirúrgicas, escalas pronósticas, manejo perioperatorio y una mayor participación e implicación del paciente. En esta nueva serie de MedicinaIntensiva se abordarán aspectos fundamentales de cómo los servicios de medicina intensiva pueden aportar valor al proceso quirúrgico, de forma coordinada con otros servicios. Se requieren políticas institucionales que aseguren la detección de pacientes en riesgo en plantas de hospitalización, el ingreso precoz en UCI de aquellos pacientes en los que está indicado, adecuando el tratamiento en la UCI y optimizando los criterios al alta. La detección y prevención del síndrome post-UCI en pacientes y familiares, y el seguimiento al alta de UCI y de hospitalización de forma multidisciplinar, pueden reducir las secuelas del enfermo crítico quirúrgico, mejorando los resultados y la calidad de vida y restituyendo al paciente a la sociedad. En futuras publicaciones de esta serie dirigida al paciente quirúrgico se presentarán actualizaciones del manejo perioperatorio de algunas de las cirugías de mayor complejidad.

Palabras clave:
Medicina intensiva perioperatoria
Unidad de cuidados intensivos
Postoperatorio

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