Critical Care and Shock

Successful prevention of rhabdomyolysis (RML) after bariatric surgery (BS) in intensive care settings



Background: Rhabdomyolysis (RML) has been increasingly recognized as a complication of bariatric surgery. It is potentially fatal postoperative complication in morbidly obese surgical patients.

Objective: Our objective was to examine the effects of interventions, implemented before and after surgery periods for morbidly obese patients to reduce the incidence of RML in an intensive care unit (ICU).

Patients and Methods: An experimental study was conducted in a surgical ICU. Multiple interventions were used to optimize RML prevention. The series of actions were performed during two phases. From January 2009 to December 2009 (control phase 1: P1 20 patients). From January 2010 to December 2010 (phase 2: P2 20 patients), we intervened in these processes at the same time that performance monitoring was occurring at the bedside, interventions were implemented using our bariatric rhabdomyolysis bundle, which consist of prevention of RML. It begins with careful intra- and post-operative padding of all pressure points and close attention to patient positioning post operatively, minimizing operative time, adequate peri- and post-operative hydration, and close postoperative monitoring are obviously essential.

Results: The incidence density of severe RML in the ICU per 25 patients was 16% in phase 1 (4 patients), reduced to 4% (1 patient) in phase 2.

Conclusion: These results suggest that reducing RML rates to zero is a complex process that involves multiple performance measures and interventions.