Preoperative care of the critically ill endocarditis patient

Up to half of patients with infective endocarditis will require surgical intervention, and 60% experience at least one major complication, which significantly increase morbidity and mortality. Complications generally result from direct damage to the heart, from vegetation embolization, or from systemic hypoperfusion due to septic or cardiogenic shock. Those with end-organ injury or heart failure require intensive care for management and preoperative optimization. This chapter discusses the management of the cardiac complications of endocarditis, including valvular insufficiency, conduction abnormalities, and acute coronary syndrome. We will then discuss the incidence and treatment of neurologic complications (including transient ischemic attack/stroke, cerebral hemorrhage, mycotic aneurysms, meningitis, cerebral abscess, encephalopathy, and seizures), renal complications (from renal infarct, glomerulonephritis, or acute interstitial nephritis), pulmonary complications (pneumonia, lung abscess, and effusion), splenic complications (infarction and/or abscess), and osteomyelitis.