Riassunto
L’elevata mortalità perioperatoria del paziente settico da sottoporre a intervento chirurgico fa sì che grande attenzione debba essere indirizzata alla ricerca di un corretto approccio multidisciplinare al problema. La condizione di shock settico e il sequestro massivo di liquidi determinato dall’irritazione del peritoneo, elementi presenti in una infezione addominale complicata, spingono il medico rianimatore a somministrare un’aggressiva fluidoterapia per il mantenimento di un’adeguata perfusione d’organo. Peraltro una resuscitazione volemica aggressiva rappresenta un momento patogenetico nella comparsa di un quadro di ipertensione addominale favorente l’insorgenza di complicanze postoperatorie e insufficienza d’organo. In questo complicato equilibrio, il monitoraggio del paziente attraverso segni clinici e tramite una valutazione emodinamica e di perfusione d’organo rappresenta una risorsa indispensabile per ottimizzare le nostre scelte terapeutiche sul singolo caso. Il capitolo affronterà queste problematiche discutendo la gestione di un paziente con una peritonite nosocomiale nelle fasi preoperatorie, intraoperatorie e postoperatorie.
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Girardis, M., Biagioni, E. (2011). Il monitoraggio perioperatorio del paziente settico. In: Allaria, B., Dei Poli, M. (eds) Il monitoraggio delle funzioni vitali nel perioperatorio non cardiochirurgico. Springer, Milano. https://doi.org/10.1007/978-88-470-1723-8_9
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