What is the evaluation and management of a patient post partial maxillectomy (surgical removal of part of the maxilla bone) presenting with dizziness after Intensive Care Unit (ICU) discharge?

From the Guidelines

Evaluation and management of a patient post partial maxillectomy coming with giddiness after ICU discharge should prioritize early mobilization and physical activity to reduce the risk of physical deconditioning and related complications, as recommended by the European Respiratory Society and European Society of Intensive Care Medicine task force on physiotherapy for critically ill patients 1. The patient's giddiness could be a result of prolonged bed rest and immobilization, which can lead to deconditioning and further complicate the clinical course.

• A thorough assessment of vital signs, neurological status, and hydration should be performed to rule out common causes of postoperative dizziness, including orthostatic hypotension, anemia, electrolyte imbalances, medication side effects, and vestibular dysfunction.
• The patient's medication list should be reviewed for potential culprits like opioids, antibiotics, or antiemetics, and adjusted as needed.
• Positioning can be used to increase gravitational stress and associated fluid shifts, through head tilt and other positions that approximate the upright position, as outlined in the steps involved in safe mobilization of critically ill patients 1.
• Mobilization has been part of the physiotherapy and should be initiated early to reduce the time to wean from mechanical ventilation and is the basis for functional recovery 1.
• The risk of moving a critically ill patient should be weighed against the risks entailed by immobility and recumbency, and no adverse effects of physical activity on the inflammatory status of critically ill patients have been demonstrated 1.
• Close monitoring is essential as giddiness could indicate more serious complications like intracranial extension of infection, cerebrospinal fluid leak, or cerebrovascular events, especially given the proximity of the maxillary sinus to critical neurovascular structures.
• If symptoms persist or worsen, advanced imaging with CT or MRI should be considered to evaluate for these complications.

From the Research

Evaluation and Management of Post-Partial Maxillectomy Patients

• The patient's symptoms of giddiness after ICU discharge may be related to various factors, including medication side effects, pain, or other underlying conditions 2, 3, 4.
• It is essential to monitor the patient's vital signs, including temperature, pulse, blood pressure, respiratory rate, oxygen saturation, pain, level of consciousness, and urine output, to identify any potential complications 5.
• Nausea and vomiting are common symptoms that can occur after surgery, and their management is crucial to prevent dehydration, electrolyte imbalances, and other complications 3, 6.
• The use of nonsteroidal anti-inflammatory drugs (NSAIDs) can cause central nervous system effects, including dizziness, vertigo, and seizures, which may contribute to the patient's giddiness 4.
• A comprehensive assessment of the patient's condition, including their medical history, current medications, and laboratory results, is necessary to determine the cause of their symptoms and develop an effective management plan 2, 3, 4, 5, 6.

Potential Causes of Giddiness

• Medication side effects, such as those caused by opioids, sedatives, or NSAIDs 2, 3, 4.
• Pain or discomfort after surgery 3, 5.
• Dehydration or electrolyte imbalances due to nausea and vomiting 3, 6.
• Other underlying conditions, such as infections or neurological disorders 4, 5.

Management Strategies

• Monitor the patient's vital signs and adjust their medication regimen as needed 5.
• Implement strategies to manage nausea and vomiting, such as pharmacotherapy, behavioral therapy, or complementary medicine 3, 6.
• Provide adequate pain management using a multimodal approach, including medications, physical therapy, and other interventions 3, 5.
• Address any underlying conditions or complications that may be contributing to the patient's symptoms 2, 3, 4, 5, 6.