Monitoring in ICU

1. Capt Sai Thu Swe

2.  Sickest patients (Multiple Diagnosis,Multi Organ Failure,Immunocompromised, Septic
and Trauma
 Move less
 Malnourished
 More obtunded (Glasgow coma scale)
 May be associated Diabetics and Heart failure or Major-organ disease.

3.  There are at least four categories of patients who need physiologic monitoring:
 1. Patients with unstable physiologic regulatory systems; for example, a patient
whose respiratory system is suppressed by a drug overdose or anesthesia.
 2. Patients with a suspected life-threatening condition; for example, a patient who
has findings indicating an acute myocardial infarction (heart attack).
 3. Patients at high risk of developing a life-threatening condition; for example,
patients immediately post open-heart surgery, or a premature infant whose heart and
lungs are not fully developed.
 4. Patients in a critical physiological state; for example, patients with multiple
trauma or septic shock.

4. ICU monitoring systems often involve a combination of bedside
monitors, electronic health records (EHR) systems, alarms, and
trained staff to interpret and respond to the data.
Continuous monitoring allows healthcare providers to detect
subtle changes in a patient's condition and respond promptly,
which is crucial in critical care settings.

5.  Repeated or continuous observations or measurements of the patient, the
physiological function, and the function of life support equipment, for the purpose
of guiding management dicisions, including when to make therapeutic
interventions, and assessment of those interventions
 A patient monitor may not only alert caregivers to potientially Life-threatening
events; many provide physiologic input data used to control directly connected life-
support devices.

6. Intensive Care Unit (ICU) monitoring involves continuous
observation of critically ill patients.
The goal is to detect changes, ensure stability, and provide timely
interventions.
Various monitoring equipment used to assess vital signs, organ
function, and more.

7. monitoring helps in making informed decisions about
patient care and treatment adjustments.
Various types of monitoring equipment are used in the
ICU to assess different aspects of a patient's health.
Some common types of monitoring in the ICU include:

8. Heart Rate (HR): Monitored using ECG.
Blood Pressure (BP): Measured with cuffs or invasive arterial lines.
Respiratory Rate (RR): Observed or using sensors.
Temperature: Monitored using thermometers or probes.

9. Central Venous Pressure (CVP): Reflects fluid status and right heart
function.
Pulmonary Artery Pressure: Assessed with a Swan-Ganz catheter
for cardiac function and fluid status.
Cardiac Output (CO) & Cardiac Index (CI): Evaluated using
thermodilution or pulse contour analysis.

10.  PA catheter
 TEE
 JVP
 CO monitor

12. Oxygen Saturation (SpO2): Monitored via pulse oximetry.
End-Tidal Carbon Dioxide (EtCO2): Assessed using capnography for
ventilation.
Arterial Blood Gas (ABG) Analysis: Measures blood gases for acid-
base balance.

13.  Intracranial Pressure (ICP): Monitored in brain injury cases with catheters.
 Electroencephalogram (EEG): Measures brain activity and detects seizures.
 Spinal Cord Function monitoring
 GCS Scoring
 BIS technology

14. BIS Technology
BIS Monitor
BIS Modules
BIS Sensor

15. Sensor Application
Apply sensor on forehead at angle
Circle #1: Centered, 2 inches above nose
Circle #4: Directly above eyebrow
Circle #3: On temple, between corner of eye
and hairline
Press around the edges of each circle to assure adhesion
Press each circle for 5 seconds

16. lntracranial pressure measurement
Ventricular
Intraparenchymal
Epidural
Adapted from Kerrand Crago,33
with permission from Elsevier.

17. Urine Output: Assesses kidney function and fluid balance.
Serum Creatinine & BUN Levels: Regular measurements to
evaluate kidney function.

18. Blood Tests: Monitors electrolytes, blood counts, coagulation, and
more.
Cultures: Samples collected for detecting infections.

19. X-rays
CT scans,
Ultrasonography : Visualizes internal organs and conditions.

20. Arterial Lines and Central Venous Catheters: Direct blood pressure
and blood gas monitoring and central venous pressure
measurements.
Pulmonary Artery Catheters: Monitors pulmonary artery pressures.

21. Bedside Monitors: Display real-time data.
Electronic Health Records (EHR): Stores patient information.
Alarms: Alert healthcare staff to critical changes.
Trained Staff: Interpret data and respond promptly.

22.  Mixed Venous saturation
 measured with PA catheter .
Normal is 65%-75% .
Low SvO2 may indicate inadequate tissue O2 delivery (even if arterial O2 is ok)
 Lactates
Increased lactate concentration and metabolic acidosis suggests anaerobic
metabolism and inadequate tissue oxygenation. lactate also increases with liver
failure and sepsis,
 ABG monitoring
Monitors acid-base balance, PaO2 and PaCO2
 Gastric Tonometry
Used to detect shock induced splanchnic ischaemia by measuring gastric luminal
PCO2 and deriving the mucosal pH

23.  Global Measures
- Reflect the adequacy of total perfusion but could be normal with local perfusion abnormalities
- SvO2 < 55% indicates global tissue hypoxia
 Organ- specific Measures
- Urine Flow
A sensitive indicator of renal perfusion provided the kidney 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

24.  NM Monitor – Standard method of monitoring drug induced NM block is to apply
a series of four low frequency (2Hz) electrical pulse to ulnar nerve at forearm, and
observe for adduction of thumb.
Total absence of thumb addction is evidence of excessive block.
Desire goal is 1 or 2 perceptible twitches, and drug infusion is adjusted to achieve
end point.
 Pain scoring
 Spirometry
 Plasma level of various drugs

25. Early Detection: Identifies subtle changes in patient condition.
Timely Interventions: Enables quick responses to critical situations.
Personalized Care: Tailors treatment plans based on real-time data.
Improved Outcomes: Reduces complications and enhances patient
recovery.

26. ICU monitoring is vital for critical care patients.
Continuous observation, advanced equipment, and skilled
healthcare professionals contribute to effective care.
Ensures patient safety and supports optimal treatment strategies.