【持续性肾脏替代治疗crrt，non-infectious causes of fever in icu课件

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1、Non-infectiouscausesoffeverinthecriticalcareunitMarionJ.Skalweit,MDPhDCaseWesternReserveUniversitySchoolofMedicineandtheClevelandVAMedicalCenterIntroductionDefiningafeverPathophysiologyoffeverNon-infectiouscausesoffeverClinicalvignettesMarkersofinfections/rapiddiagnosticsConc

2、lusionsReferencesLearningobjectivesStateseveralnon-infectiouscausesoffeverinICUpatientsIdentifysomerapidandspecificteststhatmightbeusedtodetectpathogensAppreciatethatnon-infectiouscausesoffevermaycoexistwithinfectiouscausesoffeverDisclosuresNonethatarerelevanttotoday’spresent

3、ationWhatisafever?“Thedefinitionoffeverisarbitraryanddependsonthepurposeforwhichitisdefined.”O’Grady,N.P.etal.,“Guidelinesforevaluationofnewfeverincriticallyilladultpatients:2008updatefromtheAmericanCollegeofCriticalCareMedicineandtheInfectiousDiseasesSocietyofAmerica”,Crit.C

4、areMed.,(2008)Apr;36(4):1330-49.“Asabroadgeneralization,itisreasonableinmanyICUstoconsidereveryonewithatemperatureof≥38.3ºC…tobefebrileandtowarrantspecialattention.”O’Grady,ibid.Exceptionstotherule:immunocompromisedpatients,elderlypatients,patientswithlargeabdominalwoundsorbu

5、rns,patientsonECMOorCRRT,patientswithheart,liverorkidneyfailure,patientsonantiinflammatoryorantipyreticdrugsPathophysiologyoffeverAdaptiveresponseevolvedtohelphostridselfofpathogensCytokinesreleasedbymonocyticcells(IL-1,IL-6andTNF-α)Bindtoreceptorsinthepre-opticregionoftheant

6、eriorhypothalamuswhichactivatesphospholipaseAreleasingtissuearachadonicacid,asubstrateofthecyclo-oxygenasepathwaySomecytokinescausedirectliberationofProstaglandinE2,asmallmoleculethatcrossesthebloodbrainbarrierandcausesthefiringofwarmsensitiveneuronsMarik,P.E.“FeverintheICU”C

7、hest(2000):117;855-869.MarikChest2000“Drugfever”MalignanthyperthermiaNeurolepticmalignantsyndrome(NMS)“Drugfever”withtriadoffever,rash,eosinophiliaStevens-JohnsontoxicepidermalnecrolysisPatel,R.A.andGallagher,J.C.Pharmacotherapy2010;30(1):57-69.Drugsmaycausefever5ways:interf

8、erencewithperipheralheatdissipation,alterationofCNStemperatureregula