(1)
Department of Pharmacy, New York University Langone Medical Center, New York, NY, USA
Keywords
FeverPneumoniaLinezolidCPISInfiltrateVentilatorTable 9.1
Common causes of fever in intensive care unit patients
• Pneumonia |
• In-dwelling catheters |
• Pressure sores |
• Clostridium difficile colitis |
• Sinusitis (in patients with a nasogastric tube) |
• Acalculous cholecystitis |
• Pancreatitis |
• Venous thromboembolism |
• Drug fever (refer to Table 4.12) |
Table 9.2
Prevention of hospital-acquired and ventilator-associated pneumonia
Nonpharmacological |
• Avoid tracheal intubation if possible |
• Avoid nasal intubation |
• Removal of nasogastric and endotracheal tubes when appropriate |
• Shorten duration of mechanical ventilation |
• Avoid gastric overdistention (<250 mL) |
• Subglottic suctioning (questionable efficacy) |
• Drain ventilator circuit condensate |
• Use of heat and moisture exchangers |
• Avoid unnecessary ventilator circuit changes/manipulation |
○ ○ Unless visually contaminated with blood, emesis, or purulent secretions |
• Semirecumbent positioning (between 30° and 45°, even during patient transport) |
• Maintain appropriate endotracheal cuff pressure |
• Formal infection control program |
• Appropriate hand washing and/or use of ethanol-based hand sanitizers |
○ ○ Note that the ethanol-based hand sanitizers are not sporicidal |
Pharmacological |
• Avoid unnecessary antimicrobials |
• Short-course antimicrobials |
• Avoid unnecessary stress ulcer prophylaxis that alters gastric pH |
○ ○ Sucralfate does not alter gastric pH |
• Vaccinations in the appropriate patients |
○ ○ Streptococcus pneumonia, Haemophilus influenzae, and influenza virus |
• Avoid unnecessary red blood cell transfusions |
Table 9.3
Management of hospital-acquired and ventilator-associated pneumonia
• Obtain appropriate cultures and sensitivities
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