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Monitoring in Critical Care Dr. Abdul-Monim Batiha

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Monitoring in Critical Care Dr. Abdul-Monim Batiha. General Guidelines. Monitoring ensures rapid detection of changes in the clinical status Allows for accurate assessment of progress and response to therapy

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Presentation Transcript
general guidelines
General Guidelines
  • Monitoring ensures rapid detection of changes in the clinical status
  • Allows for accurate assessment of progress and response to therapy
  • When clinical signs and monitored parameters disagree, assume that clinical assessment is correct
  • Trends are generally more important than a single reading
  • Use non-invasive techniques when possible
  • Alarms are crucial for patient safety
hemodynamic monitoring
Hemodynamic Monitoring
  • Blood Pressure
    • Can be measured intermittently with a cuff or continuously with an arterial line
    • BP does not reflect CO – BP can be high with a low CO if vasoconstriction occurs and vice versa
  • Central Venous Pressure (CVP)
    • Measured in internal jugular vein or subclavian vein, reflecting right atrial pressure
    • May be used to assess volume
hemodynamic monitoring cont
Hemodynamic Monitoring, cont…
  • Pulmonary Artery Wedge Pressure (PAWP)
    • Reflects left atrial pressure
    • Normal is 6-12 mm Hg
  • Cardiac Output (CO)
    • Usually measured by thermodilution PA catheter
    • Can also be measured by dye dilution, transesophageal Doppler, echo, or impedence plethysmography
  • EKG
    • Monitors rate and rhythm of heart
respiratory monitoring
Respiratory Monitoring
  • ABG
    • Monitors acid-base balance, PaO2, and PaCO2
  • Oxygen Saturation
    • SpO2, using a finger or other probe, measures the proportion of saturated to desaturated hemoglobin
    • Requires adequate perfusion for accuracy
    • Oxygenatio is OK if SpO2 >90%
respiratory monitoring cont
Respiratory Monitoring, cont…
  • Mixed venous O2 saturation (SvO2)
    • Measured with PA catheter
    • Normal is 65-75%
    • Low SvO2 may indicate inadequate tissue O2 delivery (even if arterial O2 is OK)
  • Lung Function
    • Aa gradient and PaO2/FiO2 ratio measure the adequacy of gas exchange
    • Arterial to end-tidal CO2 gradients indicate the adequacy of ventilation
    • PF, FEV1, and FVC help assess patients with lung dx
    • MIP/NIF is used to determine readiness for extubation
respiratory monitoring cont1
Respiratory Monitoring, cont…
  • Respiratory compliance
    • Vt/PIP-PEEP
    • A measure of the ease of inflation
    • High airway pressures during mechanical ventilation may be caused by low compliance
  • Capnography
    • End-tidal CO2 concentration is close to artrial PaCO2 levels
    • Indicates the adequacy of alveolar ventilation
organ and tissue oxygenation
Organ and Tissue Oxygenation
  • Global measures
    • Reflect the adequacy of total tissue perfusion but could be normal with local perfusion abnormalities
    • Increased lactate concentration and metabolic acidosis suggests anaerobic metabolism and inadequate tissue oxygenation…lactate also increases with liver failure and sepsis, though
    • SvO2 <55% indicates global tissue hypoxia
organ and tissue oxygenation1
Organ and Tissue oxygenation
  • Organ-specific Measures
    • Urine flow
      • A sensitive indicator of renal perfusion provided the kidneys aren’t damaged
      • Normal is 1ml/kg
    • Core-peripheral temperature
      • The gradient between peripheral (skin) temp and core (rectal) is often used as an index of peripheral perfusion
      • The less perfusion, the colder the periphery
organ and tissue oxygenation2
Organ and Tissue Oxygenation
  • Organ-specific Measures
    • Gastric tonometry
      • Used to detect shock-induced splanchnic ischemia by measure gastric luminal PCO2 and deriving the mucosal pH
    • Neurological monitoring
      • Utilizes GCS, ICP measurement, and jugular venous bulb saturation