The priority of the critical care phase of treatment is rapid and complete reversal of metabolic failure. The next 24 to 48 hours are crucial if the patient is to be fit for a second procedure. The intensive care unit must act aggressive to reverse the metabolic failure. The patient must be actively warmed, with blankets, air-warming devices or even continuous arteriovenous warming techniques. This is vital to allow correction of coagulopathy and acidosis.
Acidosis is a reflection of impaired oxygen delivery and utilization.
Perfusion must be restored to body tissues by warmed intravenous crystalloid and blood administration as necessary. Massive tissue and bowel oedema may ensue due to the activation and release of inflammatory mediators and large volumes of fluid are required. Right heart catheters should be employed as necessary to monitor cardiac filling pressures and determine oxygen delivery. Vasodilating agents such as dobutamine or the phsophodiesterase inhibitors may be necessary to help open up vascular beds. In the absence of technology that can monitor muscle and gut perfusion, the base deficit or lactate levels should be used to guide resuscitation.