Clinical Monitoring in the ICU

Clinical Monitoring in the ICU

• The Intensive Care Unit (ICU), also known as the Critical Care Unit, is an organized system providing intensive care for critically ill patients.
• The goal of the ICU is to prevent a progressive deterioration in a patient's physiological state while managing the underlying illness.

Vital Signs

• Heart rate (HR), respiratory rate (RR), blood pressure (BP), oxygen saturation (SpO2), level of consciousness, and temperature are routinely measured.
• Blood pressure, reflecting blood flow during contraction (systole) and relaxation (diastole), is measured as systolic (SBP), diastolic (DBP) and mean (MBP) pressures.
• Pulse pressure (PP) is the difference between SBP and DBP, determining peripheral palpability of arterial pressure.

Vital Signs (cont.)

• Normal ranges for vital signs are provided.
• BP can be measured non-invasively using a sphygmomanometer or invasively with arterial lines.
• Respiratory rate ranges from 12-20 breaths per minute. Tachypnea (over 20 breaths per minute) indicates respiratory distress. Bradypnea (under 10 breaths per minute) is often caused by drugs or other factors.

Mechanical Ventilation

• Mechanical ventilation (MV) is a critical supportive treatment for critically ill patients.
• Different modes of ventilation exist, such as pressure control mode and volume control mode, primarily based on how the ventilator cycles between the inspiratory and expiratory phases.
• Ventilation settings, including tidal volume and rate, depend on the patient's lung compliance.

Pulse

• Pulse is the rhythmic expansion of an artery, reflecting blood volume and contractility.
• Pulse characteristics are monitored using ECG to diagnose cardiac rhythm disorders.
• The incidence of arrhythmia is as high as 40% in ICU patients and often linked to electrolyte imbalances and fluid status.

Heart Rate

• Heart rate (HR) is counted over 60 seconds, assessing for abnormalities like tachycardia (over 100 bpm) and bradycardia (under 60 bpm).

Oxygen Saturation

• Pulse oximetry measures arterial oxygen saturation (SpO2).
• Normal ranges are 95-100%. SpO2 below 90% is a cause for concern.
• Various factors (e.g., patient movement, probe placement, hypothermia) affect the accuracy of pulse oximetry measurements.

Temperature

• Normal body temperature is 36.8°C ± 0.4°C (98.2°F ±0.7°F).
• Temperatures outside this range are clinically relevant and might indicate underlying issues such as hypothermia or fever.
• Factors influencing temperature measurements include environmental conditions, medication, and underlying medical conditions.

Level of Consciousness

• Level of consciousness (LOC) measures the degree of arousal and awareness of a patient.
• The Glasgow Coma Scale (GCS) is a tool used to assess LOC.
• Factors affecting LOC include medication, existing medical conditions, and fluid status.

Monitoring Goals

• The primary goal of monitoring is early detection and management of problems. This involves systematic monitoring of crucial parameters and recording them.
• Vital signs, respiratory status, blood gases, and other relevant lab results are central to this effort.

Patient Monitoring Parameters

• Parameters such as patient behavior (e.g., anxiety, restlessness), pain and response to treatment, respiratory status (color of secretions, breath sounds), and fluid balance (edema, urine output) require frequent evaluation. Parameters are identified according to the specific clinical situation.

Additional Monitoring Parameters

• Airway secretions, including thick or thin secretions, need monitoring.
• Unilateral or bilateral breath sounds abnormalities are important to note. Decreased or absent breath sounds could indicate various issues like tension pneumothorax.
• Sub-cutaneous emphysema, air leak from chest tubes and other potential causes are monitored in patients in mechanical ventilation.
• Skin temperature as well as gastric distension are important aspects of patient care and needs to be monitored as well.

Lab Investigations

• Complete Blood Count, electrolytes, blood urea, serum creatinine, liver function tests should be assessed regularly as part of clinical monitoring, based on the patient's condition. CXR and cultures may be ordered as needed for specific situations.

This quiz covers essential concepts in clinical monitoring within the Intensive Care Unit (ICU), focusing on vital signs such as heart rate, respiratory rate, and blood pressure. Understand the normal ranges and measurement techniques for vital signs as well as their significance in patient care. Test your knowledge on managing critically ill patients effectively.