Department of Neurology, University of Miami Health System, 1120 NW 14th Street, Miami, FL, 33136, USA.
Department of Neurosurgery, University of Miami Health System, 1120 NW 14th Street, Miami, FL, 33136, USA.
Neurocrit Care. 2021 Jun;34(3):1047-1061. doi: 10.1007/s12028-020-01072-5. Epub 2020 Aug 13.
With increasing prevalence of chronic diseases, multimorbid patients have become commonplace in the neurosurgical intensive care unit (neuro-ICU), offering unique management challenges. By reducing physiological reserve and interacting with one another, chronic comorbidities pose a greatly enhanced risk of major postoperative medical complications, especially cardiopulmonary complications, which ultimately exert a negative impact on neurosurgical outcomes. These premises underscore the importance of perioperative optimization, in turn requiring a thorough preoperative risk stratification, a basic understanding of a multimorbid patient's deranged physiology and a proper appreciation of the potential of surgery, anesthesia and neurocritical care interventions to exacerbate comorbid pathophysiologies. This knowledge enables neurosurgeons, neuroanesthesiologists and neurointensivists to function with a heightened level of vigilance in the care of these high-risk patients and can inform the perioperative neuro-ICU management with individualized strategies able to minimize the risk of untoward outcomes. This review highlights potential pitfalls in the intra- and postoperative neuro-ICU period, describes common preoperative risk stratification tools and discusses tailored perioperative ICU management strategies in multimorbid neurosurgical patients, with a special focus on approaches geared toward the minimization of postoperative cardiopulmonary complications and unplanned reintubation.
随着慢性病患病率的增加，合并多种疾病的患者在神经外科重症监护病房（神经 ICU）中已变得很常见，这给治疗带来了独特的挑战。慢性共病通过降低生理储备并相互作用，大大增加了术后发生重大医疗并发症的风险，尤其是心肺并发症，这最终对神经外科治疗结果产生负面影响。这些前提强调了围手术期优化的重要性，反过来又需要彻底的术前风险分层、对合并多种疾病患者紊乱的生理学有基本的了解，以及对手术、麻醉和神经重症监护干预可能使共病病理生理学恶化的正确认识。这些知识使神经外科医生、神经麻醉师和神经重症监护医生能够在照顾这些高危患者时保持高度警惕，并通过个体化策略来优化围手术期神经 ICU 管理，从而最大限度地降低不良结果的风险。本文重点介绍了神经 ICU 围手术期的潜在问题，描述了常见的术前风险分层工具，并讨论了针对合并多种疾病的神经外科患者的个体化围手术期 ICU 管理策略，特别关注减少术后心肺并发症和计划外再插管的方法。
