This document discusses the various monitoring systems used in intensive care units (ICU) to support critically ill patients. It covers both non-invasive and invasive hemodynamic monitoring, which measure parameters like blood pressure, heart rate, oxygen saturation to ensure tissue perfusion and oxygen delivery. Specific devices discussed include pulse oximetry, ECG, arterial lines, central venous catheters, and pulmonary artery catheters. It also discusses intracranial pressure (ICP) monitoring for patients with head injuries using devices like epidural sensors, subarachnoid bolts, or intraventricular catheters. The goal of monitoring in the ICU is to achieve stable cardiopulmonary function and optimal oxygen transport for critically ill

1. MONITORING
SYSTEM IN ICU
Centre Of Physiotherapy And Rehabilitation,
Jamia Millia Islamia
Presented by ; AL-AFSHAN
Class ; BPT 4TH Year
Subject ; physiotherapy in cardiopulmonary conditions
Presented to ; DR. JAMAL ALI MOIZ

2. INTRODUCTION
• In this presentation, we will discuss about the equipments commonly used
for monitoring and supporting the lives of critically ill patients in ICU.
• These systems primarily addresses the cardiovascular, pulmonary and
neurological systems
• The primary goal of the intensive care unit (ICU) team is the achievement
of stable cardiopulmonary function and optimal oxygen transport.
• Monitoring system in the ICU consist of ;
1. Haemodynamic monitoring
a) Non-invasive haemodynamic monitoring
b) Invasive haemodynamic monitoring
2. ICP monitoring

4. HAEMODYNAMIC MONITORING
• Monitoring hemodynamic events provides information about the adequacy
of a patient’s circulation, perfusion, and oxygenation of the tissues and
organ systems.
• The objective of hemodynamic monitoring is to ensure optimal tissue
perfusion and oxygen delivery while maintaining adequate mean arterial
blood pressure
• Hemodynamic monitoring can be accomplished using
a) noninvasive or
b) invasive methods
• Noninvasive, or indirect, hemodynamic monitoring provides physiologic
information without the risks of invasion
• Invasive, or direct, measurements are obtained by penetrating the skin
and inserting a cannula or catheter into a blood vessel, chamber of the
heart, or both.

6. NON INVASIVE HAEMODYNAMIC
MONITORING SYSTEMS
• Commonly monitored parameters include temperature, heart rate, blood
pressure and oxygen saturation, and respiratory rate
• Devices includes in this system are the following;
1. Sphygmomanometer (BP cuff)
– Purpose :
• Indirectly measures arterial blood pressure.
– Consists of:
• An inflatable bladder enclosed in a nondistensible cuff, attached to a
pressure monitoring device.
• The device may be a manual aneroid manometer or an automatic
oscillometric device..
• If using a manual cuff, auscultate for Korotkoff sounds with a
stethoscope over an artery, usually the brachial artery. If using an
automatic cuff, follow the manufacturer’s directions for operation

7. 2. Telemetry (ECG monitoring)
– Purpose:
• Continuous monitoring of heart rate and rhythm and respiratory rate
– Consists of:
• Five color-coded electrodes placed on the chest connected to a
transmitter. Radio signals are picked up by antennae and transmitted to a
central monitor at the nursing station and monitored at a distant site
(telemetry). Twelve electrodes are used for a formal ECG.
– Clinical implication:
• Artifact, or poor signal quality, can appear on telemetry because the
strength and consistency of the electrical current are interrupted. Causes
of artifact include patient movement, poor electrode contact with the
skin, or manual techniques for bronchopulmonary hygiene. Patients on
telemetry should be instructed to stay in the area monitored by telemetry
antennas.

8. 3. Pulse oximetry
– Purpose:
• A noninvasive method of measuring the percentage of hemoglobin
saturated with O2 in arterial blood.
– Consists of:
• A probe (hard plastic clip or flexible strip) with an electro-optical sensor
placed on a finger, toe, earlobe, forehead, or nose. The pulse oximeter
emits two wavelengths of light to differentiate oxygenated from
deoxygenated hemoglobin.
– Clinical implications:
• Spo2 ≤ 88% indicates the need for supplemental oxygen. The waveform
or pulse rate reading should match the ECG or palpated pulse.

10. INVASIVE HAEMODYNAMIC
MONITORING
1. Arterial line ( A- line)
– Purpose:
• To directly and continuously record systolic, diastolic, and MAP; to
obtain repeated arterial blood samples; or to deliver medications.
– Consists of:
• A nontapered Teflon catheter placed in the brachial, radial, or femoral
artery. The catheter is usually connected to a transducer that converts a
physiologic pressure into an electrical signal that is visible on a monitor.
– Clinical implications ;
• continous measurement of arterial pressure is required in case of open
heart surgery
• the A-line is displaced, the patient can lose a significant amount of blood
at the insertion site. If bleeding occurs from the line

12. 2. Central venous catheter
– Purpose ;
• Indicated for a patient with significant fluid loss and is used as a guide
to overall fluid balance.
• The measurement of CVP as a direct reflection of right heart function.
• Also provides vascular access for short-term or long-term use (days to
months) for parenteral nutrition, repeated blood sampling, administration
of vasoactive or caustic drugs or large fluid volumes, or the initiation of
transvenous cardiac pacing.
– Consists of:
• A single-lumen or multiple-lumen intravenous line placed in the
subclavian, basilic, jugular, or femoral vein, terminating in the superior
vena cava.

14. 3. Pulmonary artery catheterization (PA line, Swan-Ganz catherer)
– Purpose:
• To directly or indirectly measure PAS, PAD, PAP, LAP, RAP, CVP, core
body temperature, CI, and CO in cases of hemodynamic instability,
ARDS, acute myocardial infarction, heart failure, or shock states.
– Consists of:
• A radiopaque, multilumn balloon-tipped catheter inserted via central
venous access point ( subclavian, or internal jugular vein) passing from
the vena cava into the right atrium, through tricuspid valve into the right
ventricle, through pulmonary valve and into the pulmonary artery and
terminates.
• The catheter is connected to a transducer to allow for continuous
monitoring.
• The proximal lumen opens into the right atrium to measure CVP and CO,
and for the delivery of fluids or medications.
• The distal lumen opens into the pulmonary artery to measure PAP and to
provide access to mixed venous blood samples.

16. ICP monitoring
• ICU patients who have sustained head injury, hypoxic brain damage,
cerebral tumor or brain surgery may requires ICP monitoring
• If ICP gets too high, it can cause decreased blood flow to the brain and
potentially lead to brain damage.
• The purpose of the ICP monitoring is to continously measure the pressure
surrounding the brain and maintenance of normal central perfusion pressure
(CPP = MAP – ICP)
• Clinically, increased ICP is best detected by altered consciousness, BP,
pupillary response, temperature and respiration ( luce, 1985)

17. • Different types of ICP monitors used in ICU are the following ;
1. Epidural sensor;
– Consist of fiberoptic pneumatic sensor placed in epidural space and
connected to transducer and monitor
– The transducer does not need to be adjusted (releveled) with position
changes.
– Fair to good reliability
2. Subarachnoid bolt
– hollow bolt placed in subarachnoid space through burr hole
– The physician will determine the level at which the transducer should be
positioned.
– Poor reliability and decreased accuracy at high ICP readings.
3. fiberoptic transducer tipped catherer
– placed in the ventricle, within the parenchyma, in the subarachnoid or subdural
space, or under a bone flap.
– The transducer does not need to be adjusted (releveled) with position changes.
– Very reliable

18. 4. Intraventricular catherer (ventriculostomy)
– provide access for the sampling and drainage of cerebrospinal fluid (CSF).
– Occasionally used to administer medications
– placed in the anterior horn of the lateral ventricle through a burr hole. The
catheter connects to a transducer and to a drainage bag, where CSF collects
– The transducer must be repositioned to the appropriate level with position
changes.
– Very reliable. The gold standard due to a high level of precision. Complications
can include infection, meningitis, ventricular collapse, or catheter occlusion by
blood or brain

19. REFERENCES
• Dean E & frownfelter. Cardiopulmonary physical therapy (3rd edition)
• Hough, A. physiotherapy in respiratory care ( 3rd edition)
• Pryor, J.A. & Webber, B.A. physiotherapy for respiratory and cardiac
problems ( 2nd edition)