RT Book, Section
A1 Barr, Walter G.
A1 Robinson, John A.
A2 Hall, Jesse B.
A2 Schmidt, Gregory A.
A2 Wood, Lawrence D.H.
SR Print(0)
ID 2281427
T1 Chapter 104. Rheumatology in the ICU
T2 Principles of Critical Care, 3e
YR 2005
FD 2005
PB The McGraw-Hill Companies
PP New York, NY
SN 9780071416405
LK accessanesthesiology.mhmedical.com/content.aspx?aid=2281427
RD 2022/05/26
AB Most  ICU  admissions  for  rheumatology  patients  are  prompted  by  infection.New-onset  rheumatic  diseases  rarely  prompt  ICU  admission  in  the  absence  of  a  revealing  prodrome.In  most  patients  without  a  previously  established  collagen  vascular  disease,  suspected  vasculitis  will  be  explained  by  an  alternative  diagnosis.Immunoserologic  assessment  of  critically  ill  patients  is  a  double-edged  sword  providing  both  enlightenment  and  misleading  shadows.  All  immunoserologic  testing  must  be  interpreted  with  a  thorough  understanding  of  the  patient's  clinical  condition.Inability  to  assign  specific  diagnostic  labels  to  patients  with  severe  life-threatening  immunoinflammatory  disease  should  not  delay  therapeutic  intervention.Not  all  ischemic  skin  lesions  that  appear  to  be  vasculitis  are.  Pseudovasculitis  of  various  causes  should  always  be  part  of  the  differential  diagnosis.Empiric  trials  with  corticosteroids  can  be  a  rational  approach  to  patient  care  when  such  trials  are  carried  out  appropriately.Acute  organic  brain  syndrome  without  focal  neurologic  deficits  or  evidence  of  systemic  vasculitis  is  unlikely  to  be  secondary  to  vasculitis.Fever  in  patients  with  collagen  vascular  disease  should  be  presumed  infectious  if  accompanied  by  chills,  leukocytosis  with  a  left  shift,  or  hypotension.Patients  who  have  been  treated  with  significant  doses  of  corticosteroids  within  the  past  year  may  require  empiric  replacement  therapy  during  critical  illness  or  surgical  procedures  until  adrenal  insufficiency  can  be  excluded.