Intensive care of the surgical patient: a perspective on high-risk interventions and common pitfalls in the surgical intensive care unit.

The care of critically ill patients in surgical intensive care units involves a wide range of frequently routine interventions, many of which are traditionally based on clinical judgment or on the pathophysiology of the underlying condition. From the perspective of evidence-based medicine, however, it has become evident that a proportion of these practices is not sufficiently supported by data, some are outdated, and their continued use may result in suboptimal outcomes. This review therefore focuses on key areas of surgical intensive care in which conventional approaches are being re-evaluated in light of contemporary evidence-namely fluid therapy with emphasis on the risks of positive fluid balance and the selection of appropriate solutions, modern strategies in sedation and delirium prevention, and nutritional management in the critically ill reflecting current recommendations and the rationale for gradual escalation of energy intake. The article further addresses rational antibiotic use, transfusion strategies within the framework of patient blood management, and the issue of excessive laboratory testing contributing to iatrogenic anemia. Attention is also given to the appropriateness of interventions (over treatment) and to decision making regarding the transition of care goals in patients with terminal conditions. This review aims to provide a comprehensive and critically oriented overview of these topics in the context of the most recent data and underscores the need for ongoing research and its timely implementation into daily clinical practice in surgical intensive care.