Pyrexia - PACT - ESICM

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Task 3. Fever in specific categories of critically ill patient Lawrence KR, Adra M, Gillman PK. Serotonin toxicity associated with the use of linezolid: a review of postmarketing data. Clin Infect Dis 2006; 42(11): 1578–1583. Epub 2006 Apr 27. PMID 16652315 The Malignant Hyperthermia Association of the US, www.mhaus.org, has educational material on the website. [38]
Task 4. Understanding and treating fever 4/ UNDERSTANDING AND TREATING FEVER Knowledge concerning fever and its influence on disease progression, its relative importance in infective and non-infective circumstances and the merit of controlling fever is incompletely understood. Although fever control is commonplace in medicine and in ICU, there is conflicting evidence on the efficacy of such therapy, using paracetamol or NSAID (non-steroidal antiinflammatory drugs) for example. Furthermore, infective and non-infective fever may differ in their effect. However, an understanding of its pathogenesis is useful and its control in highly febrile states is unquestioned. Jefferies S, Weatherall M, Young P, Eyers S, Perrin KG, Beasley CRW. The effect of antipyretic medications on mortality in critically ill patients with infection: a systematic review and meta-analysis. Crit Care Resusc 2011; 13(2): 125-131. PMID 21627583 Pathogenesis and pathophysiology Several conditions, such as malnutrition, uraemia and immunosuppression, may modify the body’s thermoregulatory responses. Uraemic or immunosuppressed patients (such as those receiving steroids which are inherently antipyretic) may manifest little febrile response to bacteraemia. Hence, bacteraemia or infection in these patients may be associated with a less marked elevation of body temperature. Modest elevations, or even a fall, in body temperature in patients with these conditions may therefore be worthy of prompt investigation. Rigors can be associated with a sudden rise in body temperature and energy expenditure, leading to cardiorespiratory instability. In these circumstances, increased dependency on inotropic or ventilatory support may develop and ICU patients may suddenly begin to trigger the ventilator or manifest tachycardia and hypotension. Sudden wheezing may also point to bacteria entering the blood stream, mirroring the effect of increased airway resistance and bronchoconstriction seen in animal experiments during the infusion of endotoxin. The transfusion of contaminated blood products (now rare in regulated environments) has been known to result in sudden bacteraemia and thus serve as an unintentional model of sepsis. You may wish to read more about transfusion-related sepsis in: Palavecino E, Jacobs M, Yomtovian R. Bacterial contamination of blood products. Curr Hematol Rep 2004; 3(6): 450–455. PMID 15496280 Rigors are unpleasant for the patient, and the symptoms can be alleviated with opioid drugs. [39]
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 19 and 20: Task 2. Determining the cause of fe
Page 35 and 36: Task 3. Fever in specific categorie
Page 37 and 38: Task 3. Fever in specific categorie
Page 39 and 40: Fever in neurological disease Task
Page 41: Task 3. Fever in specific categorie
Page 45 and 46: 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

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