Pyrexia - PACT - ESICM

More documents

Recommendations

Info

Task 1. Assessing and measuring fever in ICU Stavem K, Saxholm H, Smith-Erichsen N. Accuracy of infrared ear thermometry in adult patients. Intensive Care Med 1997; 23(1): 100–105. PMID 9037647 Giuliano KK, Scott SS, Elliot S, Giuliano AJ. Temperature measurement in critically ill orally intubated adults: a comparison of pulmonary artery core, tympanic, and oral methods. Crit Care Med 1999; 27(10): 2188– 2193. PMID 10548205 Bridges E, Thomas K. Noninvasive measurement of body temperature in critically ill patients. Crit Care Nurse 2009; 29(3): 94–97. PMID 19487784 An 86-year-old lady with multiple trauma receiving mechanical ventilation for two weeks develops fever (green line, °C), without tachycardia (blue line, b/min). The recording is from the bedside computer monitor, visualising continuous measurements (vertical lines are days). There is a diurnal pattern. The diagnosis made was ventilator-associated pneumonia attributable to Pseudomonas aeruginosa. The blue arrow indicates the day of starting piperacillin and tobramycin, and the ‘lytic’ resolution of the fever is illustrated. Heart rate b/min Body temperature C Laboratory appraisal The clinical assessment is supplemented by selected laboratory measurements. The commonest of these is the leukocyte and differential counts as signs of infection include leukocytosis and a ‘left shift’. Investigators have searched for specific ‘sepsis’ markers including circulating C-reactive protein, procalcitonin and the cytokine, interleukin-6. Although the exact predictive values remain uncertain, some of these plasma factors can help to forecast the likelihood of microbial infection in a patient with fever, before the results of Gram stains, and particularly microbiological cultures, are available. On day six after trauma or surgery, development of fever and persistently high circulating IL-6 and C- reactive protein levels may be predictive for nosocomial infection. Similarly, the detection of endotoxaemia by means of rapid assay techniques may be of some predictive value in Gram-negative infection/bacteraemia and its associated morbidity. The following papers address the (limited) value of surrogate indicators of microbial infection. [8]
Task 1. Assessing and measuring fever in ICU Fassbender K, Pargger H, Müller W, Zimmerli W. Interleukin-6 and acute-phase protein concentrations in surgical intensive care unit patients: diagnostic signs in nosocomial infection. Crit Care Med 1993; 21(8): 1175–1180. PMID 8339583 Ugarte H, Silva E, Mercan D, De Mendonça A, Vincent JL. Procalcitonin used as a marker of infection in the intensive care unit. Crit Care Med 1999; 27(3): 498–504. PMID 10199528 Heyland DK, Johnson AP, Reynolds SC, Muscedere J. Procalcitonin for reduced antibiotic exposure in the critical care setting: A systematic review and an economic evaluation. Crit Care Med 2011 [Epub ahead of print] PMID 21358400 Imaging Bedside chest radiography is routinely used to detect new pulmonary infiltrates in the ICU. In this condition and in sinusitis, CT scan is associated with fewer false negative results than plain radiography. The benefits of CT, however, only rarely outweigh the inconvenience and risk of transferring the patient to the radiology department (see later sections for further discussion). Other imaging techniques include ultrasonography. Transoesophageal echocardiography can be of help for detecting pulmonary emboli and valvular lesions in endocarditis. Nuclear techniques can supplement other imaging studies, including CT and ultrasound, but are rarely used in critically ill patients with fever of unknown origin. Nuclear techniques that may be helpful to supplement imaging in the critically ill are discussed in: Dumarey N, Egrise D, Blocklet D, Stallenberg B, Remmelink M, del Marmol V, et al. Imaging infection with 18F-FDG-labeled leukocyte PET/CT: initial experience in 21 patients. J Nucl Med 2006; 47(4): 625–632. PMID 16595496 <strong>PACT</strong> module on Clinical imaging Culture techniques Specimens from sites of suspected infection, together with blood samples when indicated, should be obtained as a matter of course for Gram stain, culture and sensitivity determinations. Taking cultures should precede the use of empirical antibiotics unless undue delays are anticipated. Aspiration of pleural fluid or ascites may indicate potential sites of infection. Aspiration of localised fluid collections or abscesses can be guided by ultrasonography or CT scans. THINK: What are the indications for these types of radiological investigations and who is the best person to approach for advice in your institution [9]
Page 1 and 2: AN ESICM MULTIDISCIPLINARY DISTANCE
Page 3 and 4: LEARNING OBJECTIVES After studying
Page 5 and 6: Introduction INTRODUCTION Thirty pe
Page 7 and 8: Task 1. Assessing and measuring fev
Page 11: Task 1. Assessing and measuring fev
Page 19 and 20: Task 2. Determining the cause of fe
Page 35 and 36: Task 3. Fever in specific categorie
Page 39 and 40: Fever in neurological disease Task
Page 43 and 44: Task 4. Understanding and treating
Page 51 and 52: Self-assessment EDIC-style Type A 8
Page 53 and 54: Self-assessment Self-assessment ans
Page 55 and 56: Patient Challenges Q. Outline the p
Page 57 and 58: Patient Challenges A cardiogenic ca
Page 59 and 60: Patient Challenges Cooling techniqu
Page 61 and 62: syndrome was clear and antibiotics,
Page 63 and 64:
Patient Challenges An 18-year-old m
Page 65:
Patient Challenges often a transien
show all

Pyrexia - PACT - ESICM

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?