Role of ICU in the management of the acute abdomen

Patients with an AA often need to be admitted to an Intensive Care Unit peri-operitavely for monitoring and management of surgical and medical complications. Septic sequelae may necessitate repeated abdominal interventions, either percutaneous aspiration and drain placement or repeated laprotomies. Major systems may require support with fluids, inotropes, airway care, ventilation and renal replacement therapy. Other supportive care include nutrition, good nursing care and wound care. Newer evidence suggests that blood or packed red blood cells, albumin and anabolic steroids should be avoided or used sparingly. Early immune enhancing enteral nutrition and tight control of blood sugar may help decrease secondary infections and mortality. Low dose steroids may have a limited role in patients requiring inotropes support, and a novel therapy, the use of recombinant activated Protein C may decrease mortality in patients with severe sepsis. ICUs which offer consultant based structured services have lower mortality, lower complications, shorter duration of mechanical ventilation, shorter lengths of ICU and hospital stay and lower costs when caring for these critically ill patients.