Multimorbidity and Critical Care Neurosurgery: Minimizing Major Perioperative Cardiopulmonary Complications

Rami Algahtani, Amedeo Merenda

Research output: Contribution to journalReview articlepeer-review

Abstract

With increasing prevalence of chronic diseases, multimorbid patients have become commonplace in the neurosurgical intensive care unit (neuro-ICU), offering unique management challenges. By reducing physiological reserve and interacting with one another, chronic comorbidities pose a greatly enhanced risk of major postoperative medical complications, especially cardiopulmonary complications, which ultimately exert a negative impact on neurosurgical outcomes. These premises underscore the importance of perioperative optimization, in turn requiring a thorough preoperative risk stratification, a basic understanding of a multimorbid patient’s deranged physiology and a proper appreciation of the potential of surgery, anesthesia and neurocritical care interventions to exacerbate comorbid pathophysiologies. This knowledge enables neurosurgeons, neuroanesthesiologists and neurointensivists to function with a heightened level of vigilance in the care of these high-risk patients and can inform the perioperative neuro-ICU management with individualized strategies able to minimize the risk of untoward outcomes. This review highlights potential pitfalls in the intra- and postoperative neuro-ICU period, describes common preoperative risk stratification tools and discusses tailored perioperative ICU management strategies in multimorbid neurosurgical patients, with a special focus on approaches geared toward the minimization of postoperative cardiopulmonary complications and unplanned reintubation.

Original languageEnglish (US)
Pages (from-to)1047-1061
Number of pages15
JournalNeurocritical Care
Volume34
Issue number3
DOIs
StatePublished - Jun 2021

Keywords

  • Cardiopulmonary complications
  • Multimorbidity
  • Neurocritical care
  • Neurosurgery
  • Perioperative complications
  • Risk stratification

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Clinical Neurology

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