(精选)Fever in the ICU教学课件.pptVIP

Fever in the ICU Christopher Kia Outline Definition of fever Why fever in the ICU is important Temperature measurement Etiology - infectious and noninfectious causes Diagnostic approach Definition of Fever Normal body temperature = 37.0°C, varying with the time of day and measurement method Definition of fever is arbitrary Fever = body temperature of 38.3°C or higher, while acknowledging that this threshold may need to be lowered in immunocompromised patients (ACCCM/IDSA joint task force definition) Why Fever in the ICU is Important (1) Fever complicates 70% of all ICU admissions Often represents a serious underlying condition, but may propagate a series of unnecessary investigations and lead to inappropriate antibiotic use Fever is associated with increased length of stay in ICU, increased cost of care, poorer outcomes in certain patient groups e.g. traumatic head injury, SAH, pancreatitis Why Fever in the ICU is Important (11) In one observational study of 24,204 adult ICU admissions, high fever (≥39.5°C) alone was associated with a significant increase in mortality (20% vs 12%) Clinical assessment of ICU patients is often hampered by invasive medical technology e.g. CRRT and ECMO can modify the febrile response or mask it completely Temperature Measurement Conventional: intravascular, intravesical, rectal, oral, cutaneous, tympanic Axillary, temporal artery, tympanic and chemical dot monitors are inaccurate in critically ill patients Gold standard: thermistor on a pulmonary artery catheter (infrequently placed and may be unreliable if PAC used for rapid volume administration) Etiology Infectious and Noninfectious causes Distinguishing between both causes can be challenging, requires careful clinical assessment, both causes may coexist Fever ≥41.1°C usually noninfectious in origin Temperatures between 38.9 and 41.0°C can be assumed to be infectious in origin Serum markers (1) CRP: Acute phase protein secreted by liver, marker of inflammation, can be affected by si