Viviendas unifamiliares

Pneumonia: (The most common nosocomial infection in the ICU). Risk factors include

prolonged intubation, chest trauma and ARDS. Pathogens commonly found include: gram negative enteric organisms (Hemophilus, Pseudomonas, and Enterobacter) and/or gram positive organisms (Enterococcus, other strep species and Staphylococcus aureus).

Urinary Tract Infection: Pathogens commonly found include: E. coli, Enterococcus, Klebsiella, Pseudomonas, Enterobacter, Proteus and Candida species.

Wound Infection: The wound may be erythematous with or without purulent drainage, or

subcutaneous crepitus. A surgical wound infection may not be clinically apparent until 5 to 7 days post-operatively.

Vascular Catheter Related Infection: The risk of line infection increases with the length of

time the vascular cannula has been in place.

Sinusitis: The risk factors include: nasogastric tube, nasotracheal tube, nasal packing, facial

fractures, recumbent positions, and high dose steroids.

Intraabdominal Infection: The risk factors include: peritoneal contamination by GI contents,

ascites, or presence of intraabdominal hematoma. If a patient develops bacteremia with Klebsiella, Enterobacter, E. coli, B fragilis, or Enterococci species, an intraabdominal source should be considered and investigated.

Acalulous Cholecystitis: Any critically ill patient is at risk. Contributing factors include: opiates, fasting, TPN and shock.

Empyema: The risk factors include: pneumothorax, hemothorax, penetrating chest trauma,

unrecognized diaphragmatic perforation and pneumonia.

Tracheitis: Usually associated with tracheal intubation. Manifestations may include foul

smelling purulent tracheal secretions.

Fungal Infection: This is usually seen in immunocompromised patients or in patients who

have been critically ill for a prolonged period of time and have been on extended courses of broad spectrum antibiotics.

Vascular Grafts: Manifestations of vascular graft related infections include: wound drainage,

wound infection, graft thrombosis, septic emboli and pseudoaneurysm.

Endocarditis: Central venous catheters can be an etiologic factor. Common pathogens

include: Staphylococcus and Streptococcus.

Mediastinitis: Can be seen after surgical procedures performed through a median sternotomy

and with injuries to the aerodigestive tract.

Central Nervous System Infection: The risk factors include CSF leak (following craniotomy

Nursing Guidelines

The goal of therapy is to allow temperature elevation considering the possible benefits of immune functioning, but be aware of the harmful effects that require

immediate interventions.

1. Tissue oxygenation: Keep SvO2 > 60, SaO2 > 90, in the absence of shivering

2. Hydration: Keep PCWP > 10, CVP > 8, UOP > 30cc/hr

3. Nutrition: Consult R.D. to ensure metabolic needs are being met with current feeding regimen.

4. Pain/Sedation/Monitor for signs and symptoms of pain and assess need for sedation. Adequate sedation will help control shivering and if unsuccessful will need NMBA.

5. External cooling should only be used if temperature is > 40 C. AND the patient is receiving a NMBA or is properly sedated.

6. Antipyretics may be given if patient temperature is < 39.0  C. and adequate tissue oxygenation cannot be achieved.

7. Rectal temperatures correlate most closely with core temperatures and should be used if the patient does not have a pulmonary artery catheter, unless contraindicated or temperature sensing Foley catheter.

External Cooling:

Hyperthermia is a natural adaptive mechanism in critical illness. Hypothalamic temperature regulation is adjusted upward to accommodate the hyperthermia associated with

hypermetabolism and infection. Under these circumstances, attempts to lower temperature to normal can be harmful because CNS autoregulation has been reset at a higher core

temperature. External cooling will produce increases in sympathetic tone that markedly increase oxygen consumption. The body will attempt to restore temperature, during external cooling by stimulating skeletal muscle, producing shivering, will increase tissue oxygen consumption. External cooling will cause peripheral vasoconstriction. This will shunt heat deeper and make it more difficult to cool. Recognizing the role of hyperthermia in critical illness, a more permissive attitude is taken towards temperature elevation. Modest rise in core

temperature is monitored without treatment, and moderate temperature elevation (>102.2) is treated with antipyretics. External cooling is reserved for extreme temperature elevation (>104) when compromise of tissue oxygenation and/or direct tissue damage may occur. More

aggressive temperature control can and should be employed when marginal tissue oxygenation occurs with lower temperatures.

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