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
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
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
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
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
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, 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
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 oxygenationlactate also
increases with liver failure and sepsis, though
SvO2 <55% indicates global tissue hypoxia
Organ and Tissue oxygenation
Organ-specific Measures
Urine flow
A sensitive indicator of renal perfusion provided
the kidneys arent 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 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