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Information on various infections that commonly affect icu patients, including sinusitis, diarrhea, and urinary tract infections. It discusses the risk factors, symptoms, diagnosis methods, and treatment options for each condition. The document also mentions the microbiology of these infections and the importance of proper diagnosis and timely intervention.
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Arch Intern Med 2000, 160:449-
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Normal body temperature is generally considered to be 37.0°C(98.6°F) with a circadian variation of between 0.5 to1.0°C
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The definition of fever is arbitrary depends on the purpose for whichit is defined
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The Society of Critical Care Medicine and IDSA suggested that at^
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temperature of above 38.3°C (101°F) should be considered a feverand should prompt a clinical assessment
Frequency of fever in ICU has been variably quoted between 26%*and 44%^and 44%^
Intensive Care Med 2004; 30:811ā816Intensive Care Med 1999; 25:668ā
^Crit Care Med 2008;36:1531-
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Presence of high grade fever at admission or during ICU stay is associatedwith poor outcome
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Crit Care Med 2008;36:1531-
Method
Merits
Demerits /Limitations
Axillary temp.
Underestimates core temp.
Sublingual temp.
Food, drinks, respiratory devices
Infrared ear thermometry
Inflammation or block of externalear interferes
Rectal temp
Few tenths of °C
Rectal trauma
Rectal temp.
Few tenths of
C
above core temp
Rectal traumaCl.difficle transmission
Mixed venous blood from
Optimal site for
Needs pulmonary artery
pulmonary artery
core temperature
catheter
Thermistor in urinarybladder
Represent coretemperature
CostlyRequires monitor
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Requires monitor
Thermistor placed indistal esophagus
Represent coretemperature
Position diff. to confirmUncomfortableRisk of perforation
Hypersensitivity reaction
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Hypersensitivity reaction
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Local inflammation at the site of administration : Amphotericin B,
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KCl
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erythromycin, KCl, sulfonamides, and cytotoxic chemotherapies
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Drugs or their delivery systems may contain pyrogens or microbialcontaminants
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Stimulation of heat production e.g., thyroxine
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Limit heat dissipation
e.g., atropine
Alter thermoregulation
e.g., phenothiazines, antihistamines
antiparkinson drugsantiparkinson drugs
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Unexplained high spiking temperatures and shaking chills
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Usually in 2
nd
week of drug administration
Usually in 2
week of drug administration
May be associated with a with leukocytosis and eosinophilia
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Relative bradycardia, although commonly cited, is uncommon
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Ann Intern Med 1987; 106:728ā
Associated skin rash
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Rapid resolution of fever <72 hrs (if no rash), may take up to 7 days
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Idiosyncratic reaction to neuroleptic drugs (initiation or change of dose)
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Idiosyncratic reaction to neuroleptic drugs (initiation or change of dose)
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It manifests as altered mentation , hyperthermia, muscle rigidity,rhabdomyolysis, and autonomic dysfunctionrhabdomyolysis, and autonomic dysfunction
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Antipsychotic medicationsāphenothiazines, thioxanthenes, andbutyrophenones
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Antiemitics (prochlorperazine), prokinetics (metclopromide),sedatives (promethazine)Withdrawal of levodopa/carbidopa, amantidine
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In the ICU, haloperidol is the most common offending drug
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CNS dopamine deficiency or D2 receptor antagonism in hypothalamus,resets temperature set point
Major criteria:
Management:
Major criteria:ā¢^
Fever
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Muscle rigidity
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Elevated CPK
Management:ā¢^
Withdrawal of offending drugD
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Elevated CPK Minor criteria:ā¢^
Tachycardia
Dantrolene
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Dopamine agonists
Tachycardia
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Tachypnea
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Altered sensorium
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Abnormal BP
Bromocriptine (2.5- 5 mg TDS)Amantidine (100 mg TDS)Levodopa/carbidopa
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Diaphoresis
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Leukocytosis
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Electroconvulsive therapy
3 Major
Diagnostic
2 major + 4 minor
Supportive care
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0.2 to 1.5% of patients in ICU
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RUQ abdominal pain nausea vomiting
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RUQ abdominal pain, nausea, vomiting
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Laboratory investigations
Non specific
Gallbladder ischemia & Cholestasis with bile salt inpissationassociated with parenteral nutrition and PEEPassociated with parenteral nutrition and PEEP
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Bacterial invasion is a secondary process
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May progress to gangrene and perforation
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USG abdomen- gall bladder distension, intraluminal lucencies, wallthickening >3 mm, pericholecystic fluid
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CT abdomen ā sensitive and specific
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Hepatobiliary scintigraphy- provides functional information
high negative predictive value
Percutaneous cholecystostomy is procedure of choice
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Surgical drainage as salvage procedure
EPIC study:Single day prevalence of ICUacquired infection- 20%VAP (46.9%)UTI (17 6%)UTI (17.6%)Bacteremia (12%)
JAMA 1995; 274:639ā
Pneumonia in a patient who has been on ventilator for >48 hoursRisk of 3%/day during the first 5 days of ventilation, 2%/day duringDays 5 to 10 of ventilation and 1%/day after thatDays 5 to 10 of ventilation, and 1%/day after thatāAttributable mortalityā has been estimated to be between 33 and 50%
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ACCP definition of VAP:1.
New onset or progressively increasing infiltrates in CXR (sine quonon)
2
Fever
Fever
Leucocytosis
Purulence tracheobronchial secretions
2 out of 3