Editorial: the surgical patient

Abstract

High-risk surgical patients often require monitoring and treatment in ICUs after surgery. The term 'highrisk patient' is vague, but generally describes either patients having major surgery (such as abdominal or cardiac surgery) or patients with substantial comorbidities having any type of surgery. Caring for these patients in the first hours and days after surgery poses numerous challenges to intensivists. This issue of Current Opinion in Critical Care highlights important aspects of postoperative critical care and addresses open research questions that need to be answered to further improve the management of patients after surgery.In high-risk surgical patients, the incidence of postoperative complications remains high [1,2]. Three articles shed light into the development, detection, and treatment of three common major postoperative complications [1]-myocardial injury, acute kidney injury, and neurocognitive disorders.There is increasing evidence that perioperative myocardial injury is associated with postoperative mortality and adverse cardiovascular outcomes in patients having noncardiac surgery [3,4]. However, there is an ongoing debate on how to define perioperative myocardial injury and -even more important -how to diagnose, prevent, or treat it [5,6]. Chew and Puelacher (pp. 670-675) provide a concise summary of different concepts of myocardial injury, namely 'myocardial injury after noncardiac surgery' and 'perioperative myocardial injury'. They also give a comprehensive update on how to diagnose perioperative myocardial injury using routine troponin screening and discuss possible treatment strategies.Just like the heart, the kidneys are sensitive to perioperative organ injury [7]. The incidence of perioperative acute kidney injury is often underestimated as its detection can be challenging. In their review, give an update on the definition of perioperative acute kidney injury -a continuum ranging from normal kidney function to acute and chronic kidney disease. The authors explain recent advancements in diagnostics -especially highlighting functional biomarkers. They further expand on preventive bundles to avoid acute kidney injuryincluding haemodynamic optimization, avoiding nephrotoxins, and glycaemic control.