Pyrexia - PACT - ESICM

More documents

Recommendations

Info

Task 2. Determining the cause of fever in the critically ill patient 2/ DETERMINING THE CAUSE OF FEVER IN THE CRITICALLY ILL PATIENT Causes of fever of recent onset in the critically ill patient, in descending order of likelihood. Infective causes Ventilator-associated pneumonia Catheter-related infection Upper respiratory tract infection and sinusitis Gastrointestinal infection: Clostridium difficile Urinary tract infection Acalculous cholecystitis Endocarditis Primary Gram-negative bacteraemia Malaria. Non-infective causes Pulmonary aspiration Postoperative fever (
Task 2. Determining the cause of fever in the critically ill patient Vincent JL, Rello J, Marshall J, Silva E, Anzueto A, Martin CD, et al.; EPIC II Group of Investigators. International Study of the Prevalence and Outcomes of Infection in Intensive Care Units. JAMA 2009; 302(21): 2323–2329. PMID 19952319 O’Grady NP, Barie PS, Bartlett JG, Bleck T, Carroll K, Kalil AC, et al. Guidelines for evaluation of new fever in critically ill adult patients: 2008 update from the American College of Critical Care Medicine and the Infectious Diseases Society of America. Crit Care Med 2008; 36(4): 1330–1349. PMID 18379262 Infective causes Ventilator-associated pneumonia The longer the duration of mechanical ventilation the greater the risk of developing ventilator-associated pneumonia (VAP). Sinusitis is also a risk factor for VAP. Early diagnosis and effective treatment is associated with a lower morbidity and mortality. Confirmation of the clinical diagnosis in a ventilated patient developing fever, impaired oxygenaton and purulent sputum may be obtained by means of tracheal aspirates and a new infiltrate on chest radiography. The additional presence of pathogenic micro-organisms with leukocytes is diagnostic – see pulmonary infection score below. The preceding table is adapted from: Fartoukh M, Maitre B, Honoré S, Cerf C, Zahar JR, Brun-Buisson C. Diagnosing pneumonia during mechanical ventilation: the clinical pulmonary infection score revisited. Am J Respir Crit Care Med 2003; 168(2): 173– 179. Epub 2003 May 8. PMID 12738607 CT scanning of the thorax provides better visualisation of infiltrates than bedside chest radiography. In selected cases of suspected VAP, CT scanning can therefore be useful, even though transportation to the CT department is necessary. It may also help to recognise and allow drainage of empyema. [15]
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 17: Task 1. Assessing and measuring fev
Page 21 and 22: 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

Pyrexia - PACT - ESICM

Create successful ePaper yourself

Delete template?

Save as template?