THE PERIOPERATIVE PERIOD AND INTENSIVE CARE MEDICINE

• Autor(a) principal: Lobo Antunes, Maria
• Data de Publicação: 2024
• Outros Autores: D'Orey, Francisco, Ribeiro, Maria Inês, Mendes, Paula, Lança, Sara, Fernandes, Antero
• Tipo de documento: Artigo
• Idioma: eng
• Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
• Texto Completo: https://doi.org/10.34635/rpc.1008

High-risk surgery is related to the extent, invasiveness and complexity of the procedure, factors that result in an increased stress response due to surgical trauma, increased oxygen demand and increased rate of postoperative complications, which may lead to patient death. Classically, the perioperative period comprises three interrelated sequential phases: preoperative, intraoperative and postoperative. Regardless of the improvements in surgical treatment observed in terms of anaesthesia, surgical techniques and perioperative care, in patients considered high risk perioperative morbidity and mortality remains high, leading to an eminent need for early recognition of these patients, to allow optimizing the preoperative period by prehabilitating the most severe patients, defining the best anaesthetic-surgical strategy in the intraoperative period, and better managing the postoperative period, which if it happens improves the outcome. Various predictive risk scores and classifications are used in the different phases of the perioperative period to identify and classify patients at higher risk, enabling early identification of patients. All patients should ideally have their risk re-stratified at the end of surgery using some “criteria protocol” to determine immediate postoperative care. The evidence shows that patients considered high risk or patients with a risk of death ≥ 10% should be admitted to intensive care medicine, enabling quality immediate postoperative care. Even though they are not ideal tools, several Intensive Care Units use various indices (Charlson Comorbidity Index, Coexisting Diseases Index, the National Early Warning Score (NEWS2)), among others) as preoperative indicators for postoperative admissions. Perioperative assessment is very important and is justified by the possibility of postoperative complications, which despite having a variable incidence are still an important cause of morbidity and mortality, especially in high-risk patients. As the systemic and differentiated area of Medical Sciences that specifically addresses the prevention, diagnosis and treatment of potentially reversible acute illness situations in patients presenting with imminent or established failure of one or more vital functions, Intensive Care Medicine through the effective monitoring of the evolutionary course of high-risk patients can play a relevant role in the perioperative period, stratifying not only patients with a real risk of death or morbidity, but above all identifying and treating early postoperative complications. This article aims to revisit the main predictors of perioperative risk, but also the essential aspects of perioperative assessment, especially in patients at high risk of developing postoperative complications. It reinforces the role of intensive care medicine as an active part of the perioperative management of these patients, emphasizing the importance of admitting high-risk patients to intensive care medicine, where effective monitoring of their course and the early identification and appropriate therapeutic approach to postoperative complications that generate high morbidity and mortality clearly have a positive impact.