Subramaniam Ashwin, Wengritzky Robert, Skinner Stewart, Shekar Kiran
Department of Intensive Care Medicine, Peninsula Health, Frankston, Victoria, Australia.
Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia.
Clin Colon Rectal Surg. 2022 Feb 9;35(3):244-260. doi: 10.1055/s-0041-1740045. eCollection 2022 May.
A proportion of patients require critical care support following elective or urgent colorectal procedures. Similarly, critically ill patients in intensive care units may also need colorectal surgery on occasions. This patient population is increasing in some jurisdictions given an aging population and increasing societal expectations. As such, this population often includes elderly, frail patients or patients with significant comorbidities. Careful stratification of operative risks including the need for prolonged intensive care support should be part of the consenting process. In high-risk patients, especially in setting of unplanned surgery, treatment goals should be clearly defined, and appropriate ceiling of care should be established to minimize care that is not in the best interest of the patient. In this article we describe approaches to critically unwell patients requiring colorectal surgery and how a multidisciplinary approach with proactive intensive care involvement can help achieve the best outcomes for these patients.
一部分患者在择期或急诊结直肠手术后需要重症监护支持。同样，重症监护病房中的危重症患者有时也可能需要进行结直肠手术。鉴于人口老龄化和社会期望的增加，在一些地区，这一患者群体正在扩大。因此，这一群体通常包括老年、体弱患者或患有严重合并症的患者。仔细分层手术风险，包括对延长重症监护支持的需求，应成为知情同意过程的一部分。在高危患者中，尤其是在非计划手术的情况下，应明确治疗目标，并设定适当的护理上限，以尽量减少不符合患者最佳利益的护理。在本文中，我们描述了需要进行结直肠手术的危重症患者的处理方法，以及多学科方法与积极的重症监护参与如何有助于为这些患者实现最佳治疗效果。
