Kapoor Sumit, Bassily-Marcus Adel, Alba Yunen Rafael, Tabrizian Parissa, Semoin Sabrine, Blankush Joseph, Labow Daniel, Oropello John, Manasia Anthony, Kohli-Seth Roopa
Sumit Kapoor, Department of Pulmonary, Critical Care and Sleep, Baylor College of Medicine, Houston, TX 77030, United States.
World J Crit Care Med. 2017 May 4;6(2):116-123. doi: 10.5492/wjccm.v6.i2.116.
To study the early postoperative intensive care unit (ICU) management and complications in the first 2 wk of patients undergoing cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC).
Our study is a retrospective, observational study performed at Icahn School of Medicine at Mount Sinai, quaternary care hospital in New York City. All adult patients who underwent CRS and HIPEC between January 1, 2007 and December 31, 2012 and admitted to ICU postoperatively were studied. Fifty-one patients came to the ICU postoperatively out of 170 who underwent CRS and HIPEC therapy during the study period. Data analysis was performed using descriptive statistics.
Of the 170 patients who underwent CRS and HIPEC therapy, 51 (30%) came to the ICU postoperatively. Mean ICU length of stay was 4 d (range 1-60 d) and mean APACHE II score was 15 (range 7-23). Thirty-one/fifty-one (62%) patients developed postoperative complications. Aggressive intraoperative and postoperative fluid resuscitation is required in most patients. Hypovolemia was seen in all patients and median amount of fluids required in the first 48 h was 6 L (range 1-14 L). Thirteen patients (25%) developed postoperative hypotension with seven requiring vasopressor support. The major cause of sepsis was intraabdominal, with 8 (15%) developing anastomotic leaks and 5 (10%) developing intraabdominal abscess. The median survival was 14 mo with 30 d mortality of 4% (2/51) and 90 d mortality of 16% (8/51). One year survival was 56.4% (28/51). Preoperative medical co morbidities, extent of surgical debulking, intraoperative blood losses, amount of intra op blood products required and total operative time are the factors to be considered while deciding ICU non ICU admission.
Overall, ICU outcomes of this study population are excellent. Triage of these patients should consider preoperative and intraoperative factors. Intensivists should be vigilant to aggressive postop fluid resuscitation, pain control and early detection and management of surgical complications.
研究减瘤手术（CRS）联合腹腔热灌注化疗（HIPEC）患者术后前2周在重症监护病房（ICU）的早期管理及并发症情况。
本研究是一项在纽约市西奈山伊坎医学院（一所四级护理医院）进行的回顾性观察研究。对2007年1月1日至2012年12月31日期间接受CRS和HIPEC且术后入住ICU的所有成年患者进行研究。在研究期间接受CRS和HIPEC治疗的170例患者中，有51例术后进入ICU。采用描述性统计进行数据分析。
在170例接受CRS和HIPEC治疗的患者中，51例（30%）术后进入ICU。ICU平均住院时间为4天（范围1 - 60天），急性生理与慢性健康状况评分系统（APACHE）II平均评分为15分（范围7 - 23分）。31/51例（62%）患者出现术后并发症。大多数患者需要积极的术中及术后液体复苏。所有患者均出现血容量不足，前48小时所需液体中位数为6升（范围1 - 14升）。13例（25%）患者出现术后低血压，其中7例需要血管活性药物支持。脓毒症的主要原因是腹腔内感染，8例（15%）发生吻合口漏，5例（10%）发生腹腔内脓肿。中位生存期为14个月，30天死亡率为4%（2/51），90天死亡率为16%（8/51）。1年生存率为56.4%（28/51）。在决定患者入住ICU还是非ICU时，应考虑术前合并症、手术减瘤范围、术中失血量、术中所需血制品量及总手术时间等因素。
总体而言，本研究人群的ICU结局良好。对这些患者进行分类时应考虑术前和术中因素。重症监护医生应警惕积极的术后液体复苏、疼痛控制以及手术并发症的早期发现和处理。
