Is enhanced recovery after surgery feasible, effective and well tolerated in emergency surgery and ICU?

PURPOSE OF REVIEW: Perioperative management within an enhanced recovery after surgery (ERAS) protocol is increasingly implemented worldwide not only for abdominal, but all types of major surgery. The available evidence regarding ERAS in critical illness is limited. The purpose of this review is to discuss the feasibility, effectiveness, and safety of ERAS with special regard to the application in emergency surgery and intensive care settings. RECENT FINDINGS: ERAS has been increasingly applied after emergency and trauma surgery as well as in the ICU. Despite the inherent challenges posed by critical illness and limited patient engagement, given some adaptations implementation of ERAS treatment bundles may be feasible. Recent guidelines providing recommendations are available. SUMMARY: ERAS may be feasible after emergency surgery and in the ICU in an interdisciplinary approach. Patient-centered effectiveness may be expected even when active patient engagement is not feasible as in mechanically ventilated patients. With special regard to patients with organ failure effectiveness and safety have to be elucidated. Therefore, implementation should weigh potential risks and benefits carefully.