Monday August 14, 2006
Temporal Artery Infrared Thermometry !

As we all know that there are many different ways to measure temperature but what is the most accurate way particularly in ICU ?.

"Temporal Artery Infrared Thermometry" ( TemporalScanner - Exergen ) appears to be more accurate than ear or rectal thermometer in responding to change in fever. It is non-invasive, gentle, fast, easy and reliable to use.

From ICU perspective, there are 3 important points:

• It is as accurate as a pulmonary artery catheter 1.
• It responds faster than temperature taken rectally 2.
• New version contain anti-microbial head to prevent transmission of VRE and MRSA.

Also, it is said to be 90% more cost-effective.

It captures the naturally emitted heat from the skin over the temporal artery, taking 1,000 readings per second, selecting the most accurate. Automatically its Arterial Heat Balance system adjusts the small temperature loss from cooling at the skin.

You can watch the video here (mpeg).


Note: icuroom.net has no financial relationship with any company. Information provided here is 100% for educational purpose.

Refereces:
1. A Comparison of Measurements from a Temporal Artery Thermometer and a Pulmonary Artery Catheter Thermistor. National Conference of Clinical Nurse Specialists, Poster Section, Atlanta, GA March 14-16, 2002. - Carroll DL, Finn C, Gill S, Sawyer J, Judge B (Massachusetts General Hospital).

2. When body temperature changes, does rectal temperature lag behind? PAS Annual Meeting, Baltimore MD, May 4-7, 2002 - Greenes DS, Fleisher GR. Division of Emergency Medicine, Children's Hospital, Harvard Medical School, Boston, MA.

Sunday August 13, 2006
Antibiotics and our failure !

About a week ago, we posted a remarkable study done by Dr. Anand Kumar and coll. and recently published in Critical Care Medicine * which found that "Administration of an antimicrobial within the first hour of documented hypotension was associated with a survival rate of 80% and time to initiation of effective antimicrobial therapy was the single strongest predictor of outcome ." Unfortunately, same study found that "only 50% of septic shock patients received effective antimicrobial therapy within 6 hrs of documented hypotension !"

* Get antibiotics quickly !! - our previous pearl


On the same theme, a study published in July 2006 issue of chest 1 looked into the factors shielding physicians from administrating antibiotics early in community-acquired pneumonia (CAP). Study found that the 4 major factors which mislead physicians are:

1. Altered mental state,
2. Absence of fever,
3. Absence of hypoxia and
4. Increasing age

Another major significance of this study - Editors' note: This is probably the first study which challenges the notion adopted by The Joint Commission of Health Care Organizations (JCAHO) and the National Quality Forum that delay of antibiotics administration was directly associated with an increased mortality. Rather, study argues that prolonged TFAD (time to the first antibiotic dose) is more a marker for comorbidities due to the fact an altered mental state and the absence of fever were stronger predictors of mortality than a TFAD of more than 4 hours.
Study questions: It is very appropriate to administer antibiotics as soon as possible but why a difference of a few hours in administration will impact adversely on mortality particularly as most patients have had symptomatic disease for several days?


Few important observations in the study

* TFAD is likely to be a marker of comorbidities driving both an atypical presentation and mortality rather than directly contributing to outcome.

* In elderly patients, and especially those presenting with confusion, physicians need to be more vigilant in excluding a diagnosis of pneumonia.

* An altered mental state may not only make it difficult for physicians to make a diagnosis, it may also delay presentation to hospital.




Referece: Click to get abstract
1. Delayed Administration of Antibiotics and Atypical Presentation in Community-Acquired Pneumonia - Chest. 2006;130:11-15.