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