如何判读重症患者新发发热？.pptVIP

How to evaluation of new fever in ICU, Infection or not?;Nosocomial infection(医院感染);*;*;*;卫生部《医院感染控制质量管理评价标准》;Fever Evaluation;1. Choose the most accurate and reliable method to measure temperature based on the clinical circumstances of the patient. Temperature is most accurately measured by an intravascular, esophageal, or bladder thermistor, followed by rectal, oral, and tympanic membrane measurements, in that order (Table 2). Axillary measurements, temporal artery estimates, and chemical dot thermometers should not be used in the ICU (level 2). Rectal thermometers should be avoided in neutropenic patients (level 2).;Recommendations for Measuring Temperature-2;6. A new onset of temperature of 36.0°C in the absence of a known cause of hypothermia (e.g., hypothyroidism, cooling blanket, etc.) is a reasonable trigger for a clinical assessment but not necessarily a laboratory or radiologic evaluation for infection(level 3). 7. Critical care units could reduce the cost of fever evaluations by eliminating automatic laboratory and radiologic tests for patients with new temperature elevation (level 2). Instead, these tests should be ordered based on clinical assessment. A clinical and labo-ratory evaluation for infection, con-versely, may be appropriate in euther-mic or hypothermic patients, depending on clinical presentation. ;Blood Cultures;Blood culture system;Recommendations for Obtaining Blood Cultures-1;Recommendations for Obtaining Blood Cultures-2;Recommendations for Obtaining Blood Cultures-3;Recommendations for Obtaining Blood Cultures-4;Intravascular Devices and Fever;Recommendations for Management of Intravascular Catheters-1;4. With short-term temporary catheters—peripheral venous catheters,noncuffed central venous catheters, or arterial catheters—if catheter-related sepsis (i.e., source of the infection is a colonized catheter) is considered likely, the suspect catheter or catheters should be removed and a catheter segment cultured. Blood cultures should be