Critical care challenges after head and neck surgery

Head and neck surgical patients can pose significant management challenges in the ICU postoperatively. In this review, we provide details on the common surgeries that present to the ICU, expected complications and management strategies to improve outcomes.

Vital structure involved in breathing, swallowing and neurovascular control are located in the head and neck region posing unique challenges for critical care. A delayed extubation strategy can be performed in select patients and has the advantage of reducing hospital stay, early oral intake, return of speech and decreased respiratory infections compared to a tracheostomy. Recent literature highlights critical interventions to improve outcomes and the importance of a multidisciplinary approach for the management of these patients.

These patients require close monitoring for airway compromise, bleeding, neurological deterioration and surgical complications postoperatively. A carefully planned delayed extubation, including a plan for reintubation of a difficult airway may be required in select patients. General management includes tracheostomy care, prevention of deep vein thrombosis, following enhanced recovery after surgery guidelines and maintaining a balance between adequate pain and preservation of airway reflexes. A thorough understanding of the surgery-specific complications and close interaction between the critical care, anesthesiology and surgical teams is paramount.