Cunha Burke A
Chief, Division of Infectious Disease, Department of Medicine, Winthrop University Hospital, 222 Station Plaza North (Suite #432), Mineola, NY 11501 and Professor of Medicine, State University of New York, School of Medicine, Stony Brook, New York, USA.
Surg Neurol Int. 2013 May 6;4(Suppl 5):S318-22. doi: 10.4103/2152-7806.111432. Print 2013.
As fever is one of the cardinal signs of infection, the presence of fever in a patient in the neurosurgical intensive care unit (NSICU) raises the question of whether it is infectious in etiology. Infectious and noninfectious causes of fever in the NSICU may be determined based upon assessment of clinical signs and symptoms, the degree of temperature elevation, the relationship of the pulse to the fever (e.g., an infectious process resulting in hyperpyrexia and bradycardia), and when the fever occurs (e.g., related to the length of stay in the NSICU). There are many noninfectious disorders which contribute to temperatures >102°F in the NSICU; these include drug fevers, deep vein thrombosis, phlebitis/pulmonary embolism, acute myocardial infarction, atelectasis, dehydration, acute gout flare, malignancy, acute pancreatitis, transfusion associated hepatitis, and hemorrhage. Infectious rather than noninfectious disorders, however, are more typically associated with high-grade fevers (>102°F.) in the NSICU, and nosocomial pneumonia, (synonymous with ventilator-associated pneumonia [VAP]), is the leading culprit, followed by nosocomial infections and Clostridium difficile.
由于发热是感染的主要体征之一，神经外科重症监护病房（NSICU）的患者出现发热会引发其病因是否为感染性的问题。NSICU发热的感染性和非感染性病因可根据临床体征和症状评估、体温升高程度、脉搏与发热的关系（例如，感染过程导致高热和心动过缓）以及发热出现的时间（例如，与在NSICU的住院时间有关）来确定。在NSICU有许多非感染性疾病会导致体温>102°F；这些疾病包括药物热、深静脉血栓形成、静脉炎/肺栓塞、急性心肌梗死、肺不张、脱水、急性痛风发作、恶性肿瘤、急性胰腺炎、输血相关肝炎和出血。然而，在NSICU，感染性而非非感染性疾病更常与高热（>102°F）相关，医院获得性肺炎（与呼吸机相关性肺炎[VAP]同义）是主要罪魁祸首，其次是医院获得性感染和艰难梭菌感染。
