title: Post-operative critical care management of patients undergoing cytoreductive surgery and heated intraperitoneal chemotherapy (HIPEC).
abstract: BACKGROUND
  Cytoreductive surgery (CRS) and Heated Intraperitoneal Chemotherapy (HIPEC) results in a number of physiological changes with effects on the cardiovascular system, oxygen consumption and coagulation. The Critical Care interventions required by this cohort of patients have not yet been quantified.
  
  
  METHODS
  This retrospective audit examines the experience of a Specialist Tertiary Centre in England over an 18 month period (January 2009-June 2010) during which 69 patients underwent CRS and HIPEC. All patients were extubated in the operating theatre and transferred to the Critical Care Unit (CCU) for initial post-operative management.
  
  
  RESULTS
  Patients needed to remain on the CCU for 2.4 days (0.8-7.8). There were no 30 day mortalities. The majority of patients (70.1%) did not require post-operative organ support. 2 patients who developed pneumonia post-operatively required respiratory support. 18 (26.1%) patients required vasopressor support with norepinephrine with a mean duration of 13.94 hours (5-51 hours) and mean dose of 0.04 mcg/kg/min. Post-operative coagulopathy peaked at 24 hours. A significant drop in serum albumin was observed.
  
  
  CONCLUSIONS
  The degree of organ support required post-operatively is minimal. Early extubation is efficacious with the aid of epidural analgesia. Critical Care monitoring for 48 hours is desirable in view of the post-operative challenges.
authors.affiliation: Department of Critical Care, The Christie, Manchester, England. cooks199@hotmail.com
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Cooksley
authors.forename: Philip
authors.initials: P
authors.lastname: Haji-Michael
mesh_terms: D000328:Adult; D000368:Aged; D000698:Analgesia; D001777:Blood Coagulation; D010478:Chemotherapy, Cancer, Regional Perfusion; D003131:Combined Modality Therapy; D019468:Disease Management; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D010101:Oxygen Consumption; D010534:Peritoneal Neoplasms / Q000628:therapy*; D011182:Postoperative Care / Q000379:methods*; D011379:Prognosis; D012189:Retrospective Studies