Clinical Monitoring in the ICU (Invasive) PDF

CLINICAL MONITORING ICU Dr.Hamad Maskary M.B.CH.B  CLINICAL MONITORING IN THE ICU ‫ﻣﻜﺜﻒ‬ Patient admitted to an ICU required constant and intensive monitoring of the vital parameters. This helps in deciding...

CLINICAL MONITORING ICU Dr.Hamad Maskary M.B.CH.B  CLINICAL MONITORING IN THE ICU ‫ﻣﻜﺜﻒ‬ Patient admitted to an ICU required constant and intensive monitoring of the vital parameters. This helps in deciding about the future of management of patient who have been stabilized and in modification of treatment in the acutely ill, unstable patient. ‫اﺣﺘﺎج اﻟﻤﺮﯾﺾ اﻟﺬي ﺗﻢ إدﺧﺎﻟﮫ إﻟﻰ وﺣﺪة اﻟﻌﻨﺎﯾﺔ اﻟﻤﺮﻛﺰة‬ ‫ ﯾﺴﺎﻋﺪ ھﺬا‬.‫إﻟﻰ ﻣﺮاﻗﺒﺔ ﻣﺴﺘﻤﺮة وﻣﻜﺜﻔﺔ ﻟﻠﻤﻌﻠﻤﺎت اﻟﺤﯿﻮﯾﺔ‬ ‫ﻓﻲ اﺗﺨﺎذ ﻗﺮار ﺑﺸﺄن ﻣﺴﺘﻘﺒﻞ إدارة اﻟﻤﺮﯾﺾ اﻟﺬي ﺗﻢ‬ ‫اﺳﺘﻘﺮاره وﺗﻌﺪﯾﻞ اﻟﻌﻼج ﻓﻲ اﻟﻤﺮﯾﺾ اﻟﻤﺼﺎب ﺑﻤﺮض‬.‫ﺣﺎد وﻏﯿﺮ ﻣﺴﺘﻘﺮ‬ A- Invasive monitoring : 1.Invasive blood pressure monitoring. 2. Central venous cannulation. 3.Pulmonary artery catheterization. 4.Arterial blood gas analysis. 5.Trans esophageal Doppler. 6.Intracranial pressure monitoring B- Noninvasive monitoring : 1.Noninvasive arterial pressure monitoring. 2. Pulse oximeters. 3.Capnography. 4.Chest X ray 5.Ultrasonography. A. Invasive monitoring : 1.Invasive blood pressure monitoring : Intra-arterial pressure is typically measured from the radial, ‫ﻋﺎدة ﻣﺎ ﯾﻘﺎس اﻟﻀﻐﻂ داﺧﻞ اﻟﺸﺮاﯾﯿﻦ ﻣﻦ اﻟﺸﺮاﯾﯿﻦ اﻟﺸﻌﺎﻋﯿﺔ أو‬ axillary, or femoral arteries..‫اﻹﺑﻄﯿﺔ أ _ و اﻟﻔﺨﺬﯾﺔ‬ 2.Continuous beat to beat BP monitoring. 3.Useful in patients receiving inotropic drugs and head injury patients because both required close monitoring. 4.Used in patients with gross peripheral edema, morbidly obese ,shocked patients, and in patients need repeated blood gas analysis ABG. 5.Allows measurement of cardiac output. 6.Complications: infection, local thrombosis, damage to local nerves, bleeding and hematoma formation 2.Central venous cannulation : Insertion of long, flexible catheters into large veins entering the thorax or abdomen. superior and inferior The large veins are vena cava, internal jugular vein, subclavian vein, and femoral vein. The major indications of cv cannulation are 1.When peripheral venous access is difficult 2.For delivery of vasoconstrictors drugs. 3.For total parenteral nutrition (TPN). 4.For prolong drug therapy. 5. For hemodialysis and plasmapheresis. Complications are: Bleeding. Arrhythmia. Air emb0lism Pneumothorax Infection. Venous thromboembolism. 3. Pulmonary artery catheterization: Flow directed pulmonary artery catheters also called Swan-Ganz catheters Indications: Direct measurement of central venous pressure, pulmonary artery pressure, pulmonary capillary wedge pressure, and right side intracardiac pressure. Measurement of cardiac output and systemic and pulmonary vascular resistant. Differentiate between cardiogenic and noncardiogenic pulmonary edema. Measurement of hemodynamic and oxygen transport parameters like oxygen delivery and uptake. Complications: Pulmonary artery perforation. Thromboembolic events. Ventricular arrhythmias.  4 - Arterial blood gas analysis: Analysis of ABG gives an idea about the oxygenation status and allows the clinician to assess the elimination of carbon dioxide and metabolic parameters of the critically ill patient. The information obtained from 4 ABG analysis allows better goal directed management of the ICU patient. Parameters reflected in the ABG report are PH, PO2, PCO2, SaO2, HCO3 and base excess. ‫ ﻓﻜﺮة ﻋﻦ ﺣﺎﻟﺔ اﻷوﻛﺴﺠﯿﻦ وﯾﺴﻤﺢ ﻟﻠﻄﺒﯿﺐ‬ABG ‫ﯾﻌﻄﻲ ﺗﺤﻠﯿﻞ‬ ‫ﺑﺘﻘﯿﯿﻢ اﻟﻘﻀﺎء ﻋﻠﻰ ﺛﺎﻧﻲ أﻛﺴﯿﺪ اﻟﻜﺮﺑﻮن واﻟﻤﻌﻠﻤﺎت اﻷﯾﻀﯿﺔ‬ ‫ ﺗﺴﻤﺢ اﻟﻤﻌﻠﻮﻣﺎت اﻟﺘﻲ ﺗﻢ‬.‫ﻟﻠﻤﺮﯾﺾ اﻟﻤﺼﺎب ﺑﻤﺮض ﺧﻄﯿﺮ‬ ‫ ﺑﺈدارة ﻣﻮﺟﮭﺔ ﺑﮭﺪف‬ABG 4 ‫اﻟﺤﺼﻮل ﻋﻠﯿﮭﺎ ﻣﻦ ﺗﺤﻠﯿﻞ‬ ‫ اﻟﻤﻌﻠﻤﺎت اﻟﻮاردة ﻓﻲ‬.‫أﻓﻀﻞ ﻟﻤﺮﯾﺾ وﺣﺪة اﻟﻌﻨﺎﯾﺔ اﻟﻤﺮﻛﺰة‬ HCO3‫ و‬SaO2‫ و‬PCO2‫ و‬PO2‫ و‬PH ‫ ھﻲ‬ABG ‫ﺗﻘﺮﯾﺮ‬.‫واﻟﻔﺎﺋﺾ اﻷﺳﺎﺳﻲ‬  PH: normal arterial blood PH is (7.35 - 7.45). Below 7.35 indicate acidosis and more than 7.45 indicate alkalosis. PaO2: normal range is 75_100 mmHg. Values 0f PO2 below 60mmHg indicate the need for mechanical ventilation for the patient. The conditions with low P02 in the ICU are: Hypoventilation, impaired diffusion, V/Q mismatch  ‫ﯾﻘﯿﺲ ﺳﺮﻋﺔ ﺗﺪﻓﻖ اﻟﺪم ﻓﻲ اﻟﺸﺮﯾﺎن اﻷورطﻲ اﻟﮭﺎﺑﻂ ﺑﻮاﺳﻄﺔ‬ 5-Transesophageal Doppler:.‫ﻣﺤﻮل دوﺑﻠﺮ اﻟﻤﻮﺿﻮع ﻓﻲ طﺮف ﻣﺴﺒﺎر ﻣﺮن‬ TED measures blood flow velocity in the descending aorta by Doppler transducer placed at tip of a flexible probe. It estimates preload, myocardial contractility and vascular tone. It is minimally invasive, inserted rapidly; interference occurs by nasogastric tube and can get dislodged by movement leading loss of signal ‫إﻧﮫ ﯾﻘﺪر اﻟﺘﺤﻤﯿﻞ اﻟﻤﺴﺒﻖ واﻧﻘﺒﺎض ﻋﻀﻠﺔ‬.‫اﻟﻘﻠﺐ وﻧﺒﺮة اﻷوﻋﯿﺔ اﻟﺪﻣﻮﯾﺔ‬ ‫ وﯾﺘﻢ إدﺧﺎﻟﮫ ﺑﺴﺮﻋﺔ؛‬،‫ إﻧﮫ أﻗﻞ ﺑﻀﻌﺎ‬ ‫ﯾﺤﺪث اﻟﺘﺪاﺧﻞ ﻋﻦ طﺮﯾﻖ اﻷﻧﺒﻮب اﻷﻧﻔﻲ‬ ‫اﻟﻤﻌﺪي وﯾﻤﻜﻦ أن ﯾﻨﺰع ﻋﻦ طﺮﯾﻖ اﻟﺤﺮﻛﺔ‬ ‫ﻣﻤﺎ ﯾﺆدي إﻟﻰ ﻓﻘﺪان اﻹﺷﺎرة‬ 6-Intracranial pressure monitoring: Normal ICP is in the range (10 -15) mmHg. Devices of ICP monitoring are intraventricular catheter, epidural catheter and subdural catheter. Indications: Head injury. Hydrocephalus. Brain tumor. Cerebral edema. Intracranial hemorrhage