Critical care challenges in orthopedic surgery patients.
OBJECTIVE
To review common and life-threatening complications resulting in intensive care unit admission for patients undergoing orthopedic surgery procedures. To identify specific diagnostic techniques and treatment modalities that may improve the outcome of critically ill orthopedic surgery patients.


METHODS
A review of the current literature regarding the care of orthopedic surgery patients was performed.


RESULTS
Orthopedic surgery patients are vulnerable to a number of complications, particularly pulmonary complications related to scoliosis surgery, embolic complications of joint arthroplasty, and complications related to the use of opioids and sedatives in an elderly population. They also are susceptible to transfusion-related complications such as transfusion-related acute lung injury and transfusion-associated circulatory overload. Specific strategies for management of these complex patients are identified.


CONCLUSIONS
Orthopedic surgery patients represent a significant and growing proportion of patients in intensive care units. They develop unique complications, and management of these complications requires understanding of preoperative co-morbidities, intraoperative management, and early recognition and treatment of postoperative complications. Prevention and early identification of these complications are the most efficacious routes to improving outcomes in this patient population.
Taylor
John M
JM
Department of Anesthesia and Perioperative Care, University of California, San Francisco, School of Medicine, San Francisco, CA, USA.
Gropper
Michael A
MA
D000402:Airway Obstruction / Q000517:prevention & control; D001145:Arrhythmias, Cardiac / Q000209:etiology / Q000517:prevention & control; D003422:Critical Care / Q000379:methods*; D006801:Humans; D007362:Intensive Care Units; D008171:Lung Diseases / Q000209:etiology / Q000517:prevention & control; D019637:Orthopedic Procedures; D010149:Postoperative Pain / Q000517:prevention & control; D018570:Risk Assessment; D014652:Vascular Diseases / Q000209:etiology / Q000517:prevention & control