[The surgical patient in critical state. Progress in the diagnostic-therapeutic process]

Bases on advances in scientific knowledge, we have reviewed the circumstances under which patients recommended for surgery may enter a critical state pre, trans, and post-operatory period and the physiopathological changes that these patients undergo: hypovolemia; systemic inflammatory response syndrome; infection; sepsis; septic shock; and multiple organic failure. We have analyzed the utility of advantages in diagnostic procedures, with emphasis on non-invasive methods, the dosage of inflammation intermediaries, and the use of prognostic indices. We have also looked into effective circulation volume replenishment, organ function failure, the rational application of vasoactive amines, antibiotics, and monoclonal antibodies, as well as surgery with septic focus elimination, and pre- and post-operation nutritional support.