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Complications of ICU Management

Complications of ICU Management. Ming Li. Why should we care?. Strong linkage to patient mortality! Nosocomial infections in 10 % of ICU patients 2008 – Medicare reimbursement measures. Ventilator Associated Pneumonia (VAP). PNA after 48 hrs of intubation

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Complications of ICU Management

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  1. Complications of ICU Management Ming Li

  2. Why should we care? • Strong linkage to patient mortality! • Nosocomial infections in 10% of ICU patients • 2008 – Medicare reimbursement measures

  3. Ventilator Associated Pneumonia (VAP) • PNA after 48 hrs of intubation • Leading cause of M&M in ventilated pts • Incidence 10-25% • Mortality rate 5-27% • VAP = $40,000 additional cost

  4. Prevention of VAP • Gastric pH • Positioning • Subglottic aspiration

  5. Gastric pH • H2 Blockers • Proton Pump Inhibitors • Sucralfate (misoprostol) – may be preferable

  6. Positioning

  7. Subglottic aspiration • Conclusion  Promising but more research needs to be done

  8. Catheter Related Bloodstream Infections • 5 million CVCs inserted per year • >15% of patients have complications • 5-26% have infectious complications • Mortality rate 12-25% for CRBSIs

  9. Prevention of Central Venous Catheter (CVC) Infections • Sterile Technique • Duration • Ultrasound guidance • Antibiotic-impregnated catheters

  10. Sterile Technique

  11. Duration

  12. Ultrasound Guidance

  13. Antibiotic-impregnated catheters

  14. Conclusions • VAP • Gastric pH • Positioning • Subglottic aspiration? • Central venous catheter infections • Sterile technique • Duration • Ultrasound guidance • Antibiotic-impregnated catheters

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