Complications of ICU Management
Ming Li
Strong linkage to patient mortality! Nosocomial infections in 10% of ICU
patients 2008 – Medicare reimbursement measures
Why should we care?
31%
27%
19%
23%
Urinary Tract PneumoniaPrimary blood streamMiscellaneous
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
Ventilator Associated Pneumonia (VAP)
Gastric pH
Positioning
Subglottic aspiration
Prevention of VAP
H2 Blockers Proton Pump Inhibitors
Sucralfate (misoprostol) – may be preferable
Gastric pH
Positioning
Subglottic aspiration
• Conclusion Promising but more research needs to be done
5 million CVCs inserted per year
>15% of patients have complications◦ 5-26% have infectious complications
Mortality rate 12-25% for CRBSIs
Catheter Related Bloodstream Infections
Sterile Technique
Duration
Ultrasound guidance
Antibiotic-impregnated catheters
Prevention of Central Venous Catheter (CVC) Infections
Sterile Technique
Duration
Ultrasound Guidance
Antibiotic-impregnated catheters
VAP◦ Gastric pH◦ Positioning◦ Subglottic aspiration?
Central venous catheter infections◦ Sterile technique◦ Duration◦ Ultrasound guidance◦ Antibiotic-impregnated catheters
Conclusions