Intensive Care in Digestive Surgery
Gastrointestinal and hepatobiliary diseases in the neonatal and pediatric patient result from both congenital and acquired conditions.
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Intensive Care in Digestive Surgery Andrea Gentili, Rosina De Rose, and Elisa Iannella
5.1
Introduction
Postoperative admission to the pediatric intensive care unit (PICU) is foreseen for all pediatric patients undergoing major digestive surgery and all children with a basic critical illness, often unrelated to the abdominal problem that leads to surgery, which requires monitoring and/or intensive treatment. Hospitalization in intensive care increases the security of critical patients in the delicate phase that follows the surgery, characterized by the need to maintain a proper respiratory, cardiovascular, and metabolic function and stabilization of these features, together with the need for analgesia and sedation, appropriate fluid therapy and electrolyte compensation, neurological monitoring, and prevention/treatment of infections. It should also be pointed out that for some diseases, often typical of the neonatal age, such as esophageal atresia, abdominal wall defects, and necrotizing enterocolitis, the surgery is part of an intensive treatment, which begins at birth and which also involves an important phase of preoperative treatment and stabilization. For these clinical conditions, the more correct term is perioperative intensive care [1].
A. Gentili (*) • R. De Rose • E. Iannella Department of Pediatric Anaesthesia and Intensive Care, S. Orsola-Malpighi University Hospital, Via Massarenti 9, Bologna, Italy e-mail: [email protected]; rosina.derose@ aosp.bo.it; [email protected]
5.2
Intensive Monitoring
Monitoring is one of the main prerogatives of intensive perioperative hospitalization, which may involve pathologies with clinical controls and rapid autonomization or others requiring long and complex assistance. Particular importance is given to respiratory monitoring, with attention to the type of mechanical ventilation, the respiratory weaning, and the techniques of noninvasive respiratory assistance, and to the cardiovascular, metabolic and electrolyte, temperature, and neurological monitoring carefully tailored to the level of consciousness and sedation of the patient. The respiratory monitoring involves simple and noninvasive instrumentation ranging from pulse oximetry and capnography to the reading of volumes, pressures, and compliance curves present during mechanical ventilation. An important control is that of the arterial blood gases, which offers the opportunity to further monitor oxygenation parameters such as alveolar-arterial gradient oxygen (A-aDO2), oxygenation index (OI), arterial-alveolar ratio (a/AO2), and PaO2/FiO2 ratio, useful in the evaluation of the postoperative alveolar recruitment in many challenging diseases such as esophageal atresia, omphalocele, and gastroschisis. The traditional control of the chest with imaging through X-ray until the computed tomography is now usefully supplemented by the use of ultrasound lung, easily repeatable and usable in the control/treatment of conditions
© Springer International Publishing Switzerland 2017 M. Lima (ed.), Pediatric
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