ABSTRACT
An 80-year-old female with a history of chronic obstructive pulmonary disease and diabetes mellitus undergoes an emergent Hartmann procedure for perforated diverticulitis. She is brought to the surgical intensive care unit (ICU) ventilated mechanically after receiving several liters of crystalloid and two units of blood intraoperatively. She has normal hemodynamics and is alert on ICU admission with adequate urine output. Overnight, she becomes hypotensive, requiring large-volume fluid resuscitation and intermittent vasopressor support. She is kept intubated. On postoperative days 1 and 2, vasopressor support is withdrawn gradually, and diuresis is begun in anticipation of extubation. Enteral feedings are begun via the nasogastric route.
