The first part of the critical care guidelines of the Philippine College of Surgeons (PCS) and supported by Glaxo Wellcome Philippines, Inc. dealt with resuscitation fluids, blood transfusion, assessment of volume resuscitation, nutritional support and cardiovascular support. The second part deals with the last 2 aspects identified by the Technical Working Group (TWG) namely: surgical intensive care units and implementation of guidelines. The literature search, limited to english publications. Used both electronic and manual methods. Three electronic databases were used: 1) The Cochrane Library, Issue 4, 2000; 2) National Library of Medicine - Medline (PubMed, no time limit): and HERDIN (Health Research and Development Information Network) Version 1, 1997 of DOST-PCHRD. Manual searching of the reference lists of review articles and some important meta-analyses and randomized controlled trials (RCTs) was also done. The search terms used were: 1) Cochrane library: surgical intensive care, guidelines implementation, 2) Medline: surgical intensive care, 3) HERDIN: intensive care. Titles of all articles were printed and all members of the TWG went over the list and checked the titles of articles whose abstracts they felt should be read. The abstracts of all checked articles were printed. The printed abstracts were given to the members, who then decided which articles were to be included for full text retrieval. The full texts were obtained from the University of the Philippines Manila Library, and were appraised using standard forms. (Author)

National Library Of Medicine (u.s.) ; Philippines ; Medline ; Pubmed ; Libraries ; Critical Care ; Nutritional Support ; Information Services ; Blood Transfusion ; Surgeons

It is the practice in most health care institutions in our country to have patients for elective surgery evaluated pre-operatively by Internists and Anesthesiologists. Practitioners don’t seem to agree on how this is to be carried out. Each institution has its own protocol and even individual physicians have their own preference, which they have learned either during their training or from experience. Physicians usually request for preoperative tests for patients undergoing elective surgery in order to minimize risk, and to serve as a baseline to detect subsequent changes. Several authors agree to this as the goal of pre-operative evaluation. This is being done to identify risk factors and to screen broadly for undiagnosed disease. Undiagnosed clinical conditions are correlated with the risk of complications during the perioperative period. This then allows the physician to identify patients with increased risk of morbidity and mortality, and to help them design preoperative strategies that can reduce these risks. These tests can be helpful to stratify risk and guide postoperative management; however, most of them are obtained because of protocol rather than medical necessity. Majority of surgeries performed are non-cardiac in nature. Mortality rates for these procedures can be as high as 4% depending on the patient’s risk and type of surgery. Cardiovascular complications account for half of all morbidities and mortalities in the perioperative period for patients undergoing non-cardiac surgery.
Human ; Male ; Female ; Adult ; Elective Surgical Procedures ; Preoperative Care ; Surgeons ; Universities