Parameters for Evaluating New Fever in Critically Ill Adult 为评估在危重成人新发烧实践参数课件.pptVIP

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Parameters for Evaluating New Fever in Critically Ill Adult 为评估在危重成人新发烧实践参数课件.ppt

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Parameters for Evaluating New Fever in Critically Ill Adult 为评估在危重成人新发烧实践参数课件

Approach of Infected patient in Critical Care Unit Mazen Kherallah, MD, FCCP Consultant, Infectious Disease Critical Care Chairman, Critical Care Department King Faisal Specialist Hospital Research Center 1. What Sepsis Syndrome are we Dealing with? Infection Sepsis Severe sepsis Septic shock Multi-organ system failure ACCP/SCCM Consensus Definitions Infection Inflammatory response to microorganisms, or Invasion of normally sterile tissues Systemic Inflammatory Response Syndrome (SIRS) Systemic response to a variety of processes Sepsis Infection plus ?2 SIRS criteria Severe Sepsis Sepsis Organ dysfunction Septic shock Sepsis Hypotension despite fluid resuscitation Multiple Organ Dysfunction Syndrome (MODS) Altered organ function in an acutely ill patient Homeostasis cannot be maintained without intervention SIRS: More Than Just a Systemic Inflammatory Response SIRS: A clinical response arising from a nonspecific insult manifested by ?2 of the following: Temperature ?38°C or ?36°C HR ?90 beats/min Respirations ?20/min WBC count ?12,000/mL or ?4,000/mL or 10% immature neutrophils Recent evidence indicates that hemostatic changes are also involved Severe Sepsis: Acute Organ Dysfunction and Disordered Hemostasis Severe Sepsis: Sepsis with signs of organ dysfunction in ?1 of the following systems: Cardiovascular Renal Respiratory Hepatic Hemostasis CNS Unexplained metabolic acidosis Sepsis Syndromes Sepsis Parameters: Leukocytosis with left shift Bandemia Toxic granulation Elevated sed. Rate C- reactive protein Acute phase reactant: fibrinogen, haptoglobin,.. IL1, IL6, IL8 2. Organ Localization of infection Skin Soft tissue CNS Upper airway Lower airway Head and neck Mediastinal GI Liver Biliary tract Intra-abdominal Bones and joints Urinary tract Genital tract Blood stream infection Systemic 3. Tissue Localization of Infection Skin and soft tissue: Superficial epidermal layers (impetigo) Deeper epidermal layers (Icthyma) Superficial subcutaneous: Erysip