Postoperative Critical Care Management Considerations

Abstract

Critical care in patients managed by EndoVascular resuscitation and Trauma Management (EVTM) is like standard intensive care in many respects. However, femoral access, Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA), and grafts/stents are means that are specific and impose considerations. Femoral access via large-bore sheaths introduces a risk of limb-threatening complications, which motivates additional frequent monitoring, including distal perfusion and possibly noninvasive near-infrared spectroscopy of the lower limb. Aortic occlusion has challenging postreperfusion cardiovascular effects, e.g., a vasodilatory shock, on top of the hemorrhagic shock and postresuscitation physiology, which may warrant advanced cardiovascular monitoring to initiate adequate resuscitation. Due to the ischemia-reperfusion injury of distal (abdominal) organs, use of REBOA possibly increases the risk of postresuscitation distal organ dysfunctions, especially renal failure, mesenteric ischemia, abdominal compartment syndrome, and multiple organ failure. A high level of clinical suspicion is demanded. Implantation of vascular grafts and stents prompts early anticoagulation in patients with an elevated risk of bleeding to avoid thromboembolic events; correct timing, dosing, and individual assessment are critical components. Knowledge from adjacent areas is useful in the creation of guidelines for postoperative critical care in EVTM patients, but future work should aim to explore EVTM-specific critical care considerations.