Fever in ICU - Fever in ICU DM Seminar Dr Vamsi Krishna Mootha Dept of Pulmonary medicine Fever Complex physiologic reaction to disease involving a

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Fever in ICU DM Seminar Dr. Vamsi Krishna Mootha Dept of Pulmonary medicine
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Fever omplex physiologic reaction to disease involving a Complex physiologic reaction to disease involving a cytokine mediated rise in core temperature, generation of acute-phase reactants, and activation of numerous p, physiologic endocrinologic and immunologic systems Arch Intern Med 2000, 160:449-456
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athogenesis Pathogenesis Exogenous pyrogens: Organ vasculosum of lamina terminalis eficient blood brain barrier •Endotoxin •Staphylococcal toxin •viruses Deficient blood brain barrier •Signal transduction by vascular endothelium COX-2 Prostaglandin E2 Lymphocytes Decreased firing of heat sensitive neurons Endogenous pyrogens: •IL1 Decrease in heat loss •TNF α •IL6 Increased heat production Fever
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ever Fever 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 The definition of fever is arbitrary depends on the purpose for which it is defined The Society of Critical Care Medicine and IDSA suggested that a temperature of above 38.3°C (101°F) should be considered a fever and should prompt a clinical assessment
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ever in ICU Fever in ICU Frequency of fever in ICU has been variably quoted between 26%* nd 44%^ and 44%^ *Intensive Care Med 2004; 30:811–816 *Intensive Care Med 1999; 25:668–673 ^Crit Care Med 2008;36:1531-1535 Presence of high grade fever at admission or during ICU stay is associated with poor outcome p Crit Care Med 2008;36:1531-1535
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ever in ICU Fever in ICU Apart from infections a variety of environmental factors can alter mperature: temperature: Specialized mattresses ot lights Hot lights Air conditioning Cardiopulmonary bypass •P eritoneal lavage, dialysis, and continuous hemofiltration e to ea a age, d a ys s, a d co t uous e o t at o A substantial proportion of infected patients may be euthermic or hypothermic: Elderly, patients with open abdominal wounds, burns Patients receiving ECMO, CRRT Patients with CHF, CRF, end-stage liver disease Patients taking anti-inflammatory or antipyretic drugs Even in the absence of fever other signs of SIRS and sepsis should prompt appropriate therapeutic and diagnostic steps
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easurement of temperature Measurement of temperature Method Merits Demerits /Limitations Axillary temp. Underestimates core temp. Sublingual temp. Food, drinks, respiratory devices Infrared ear thermometry Inflammation or block of external ear interferes ectal temp ew tenths of ° ectal trauma Rectal temp. Few tenths of C above core temp Rectal trauma Cl.difficle transmission Mixed venous blood from Optimal site for Needs pulmonary artery pulmonary artery core temperature catheter Thermistor in urinary bladder Represent core temperature Costly equires monitor p Requires monitor Thermistor placed in distal esophagus Represent core temperature Position diff. to confirm Uncomfortable Risk of perforation
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auses of fever in ICU Causes of fever in ICU
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Non infectious causes Except drug fever and transfusion reactions, temperature rarely reaches 39°C (102°F) Chest 2000;117;855-869
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This note was uploaded on 12/03/2011 for the course MEDICINE 350 taught by Professor Dr.aslam during the Winter '07 term at Medical College.

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Fever in ICU - Fever in ICU DM Seminar Dr Vamsi Krishna Mootha Dept of Pulmonary medicine Fever Complex physiologic reaction to disease involving a

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