ICU Monitoring:
Intensive Care:
- Close monitoring and constant medical care of patients with life-threatening conditions.
- ICU care is a 24-hour management system to support failing life functions.
- An area set aside for patients who are critically ill.
Types of ICU:
- Neonatal ICU
- Special Care Baby Unit
- Pediatric ICU
- Psychiatric ICU
- Coronary Care Unit
- Medical Intensive Care Unit
- Surgical Intensive Care Unit
- Cardiac Surgery Intensive Care Unit
- Neuroscience Critical Care Unit
- Overnight Intensive Recovery
- Neuro ICU
- Burn Wound ICU
- Trauma ICU
- Shock ICU
Basic Design:
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Room Layout:
- Large, windowless room with easy access.
- Well-illuminated and air-conditioned.
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Bed Setup:
- 8 to 12 beds per unit is recommended for functionality.
- Each bed is ideally 20 m^2 square.
- Single rooms ideally larger than 25 m^2.
- Each bed is equipped with:
- Monitor
- Suctioning apparatus
- Piped oxygen air supply
- Vacuum supply
- Recommended outlets: 3 oxygen, 2 air, and 4 suctioning outlets.
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Electrical Setup:
- 20 to 24 main sockets for each bed.
- Powerpoint essential for X-ray equipment.
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Nursing Station:
- Central nursing station for monitoring and care coordination.
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Isolation Room:
- Consideration for an isolation room within the ICU.
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Backup Supplies:
- Emerging backup supplies for air, oxygen, and suctioning power in case of failure.
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Special Facilities:
- A hemodialysis facility is provided for each bed.
Reasons for ICU Admission (CRHF):
- Coma or Deterioration of Consciousness
- Respiratory Insufficiency (R)
- Hemodynamic Insufficiency (H)
- Fluid and Electrolytic Imbalance (F)
Principles of ICU Management:
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Data Collection:
- Gathering information through repeated or continuous observation.
- Additional physical assessments and standard diagnostic tests, including laboratory and radiological findings.
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Data Analysis:
- Analyzing and interpreting collected data.
- Requires extensive knowledge of normal and abnormal parameters and their significance in different disease states.
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Decision Making:
- Sound decision-making follows data collection and analysis.
- Involves assessing the benefits and risks of available management options.
- Choosing the approach most likely to benefit or least likely to harm the patient.
The ICU Team:
- Intensivists:
- Clinicians specializing in critical illness care.
- Critical Care Nurses:
- Nurses trained in providing care for critically ill patients.
- Infectious Disease Team:
- Experts in managing infections and preventing their spread within the ICU.
- Respiratory Therapists:
- Professionals specializing in managing respiratory conditions and therapies.
- Physiotherapists:
- Experts in rehabilitation and physical therapy for ICU patients.
- Pharmacologists:
- Specialists in medication management and pharmacology.
- Dieticians:
- Professionals specialized in nutrition planning for critically ill patients.
- Other Physicians:
- Various specialists trained in medical fields such as anesthesiology, cardiology, radiology, surgery, neurology, psychiatry, etc.
ICU Equipment:
- Life Support and Emergency Resuscitative Equipment:
- Equipment is crucial for maintaining vital functions and responding to emergencies.
- Patient Monitoring Equipment:
- Devices for continuous monitoring of vital signs and patient status.
- Infusion pumps supply the patient with an IV or epidural through the catheter
- Crash carts for immediate availability when patients experience cardio-respiratory failure. the cart holds a defibrillator, a resuscitator
- Other: Tracheal intervention, broncho scope, chest drains, cardiac pacing, intra aortic balloon pumps, suction equipment, non-invasive monitor, Mechanical ventilator, AMBU
Primary Concerns:
1. Acid-Base Balance
- Monitoring pH levels
- Assessing bicarbonate and carbon dioxide levels
- Correcting acidosis or alkalosis as necessary
2. Fluid and Electrolyte Status
- Monitoring fluid intake and output
- Assessing electrolyte levels (sodium, potassium, chloride, etc.)
- Replacing electrolytes as needed
3. Hemodynamic Status
- Monitoring blood pressure
- Assessing heart rate and rhythm
- Evaluating cardiac output
4. ECG Monitoring
- Continuous electrocardiogram monitoring
- Detecting arrhythmias or ischemic changes
5. Ventilator Monitoring
- Monitoring respiratory rate and effort
- Assessing tidal volume and oxygenation
- Adjusting ventilator settings as required
6. ICP Monitoring (Intracranial Pressure)
- Monitoring intracranial pressure levels
- Assessing for signs of increased pressure
- Implementing interventions to manage elevated ICP
ICU Monitoring:
Two Types of Monitoring:
- Non-invasive monitoring
- Invasive monitoring
Non-invasive Monitoring:
- Involves procedures that gather data externally
- Examples include:
- Blood pressure monitoring
- Temperature monitoring
- Pulse rate monitoring
- ECG monitoring
- Oxygen saturation monitoring
Temperature Monitoring:
- Conducted by nursing personnel and recorded in nursing flow sheets
- Elevated temperature may indicate:
- Infection
- Systemic inflammation
- Response Syndrome
- Leukemia, etc.
Core Temperature:
- Measured at the esophagus or tympanic membrane for greater accuracy
Pulse Rate Monitoring:
- The pulse rate should be obtained and recorded before, during, and after certain procedures
- Example: administration of aerosolized bronchial dilators
- A rate over 120 per minute suggests an acute problem
- In addition to the rate, the rhythm, and strength should also be assessed.
ECG Monitoring:
- ECG detects and manages dysrhythmias such as tachycardia, bradycardia, atrioventricular dissociation, ventricular tachycardia, and atrial flutter.
- It provides continuous surveillance of the patient regardless of activity levels.
- Detects low and high heart rates; abnormalities trigger alarms.
Pulse Oximeter:
- Offers a quick, simple, and fairly accurate method to assess and monitor arterial oxygen saturation.
- Utilized for continuous monitoring of oxygen saturation levels.
Invasive Monitoring:
- Involves procedures requiring inserting a sensory or collection device into the body, offering more accuracy but carrying higher risks.
- Various procedures include:
- Intravenous lines
- Central venous pressure monitoring
- Chest drainage
- Fluid collection
- ICP monitoring
- Hemodynamic monitoring
- Intra-arterial lines
IV Lines:
- Routinely established in the patient's superficial veins.
- Provide immediate access to fluid, electrolyte, nutrition, and medication administration.
CVP (Central Venous Pressure):
- Monitored via venous lines in the subclavian, jugular, basilic, and femoral veins.
- Measures pressure in the vena cava and right atrium.
- Measured at end-diastole.
- Normal CVP ranges from 0 to 5 cm of H2O at the sternal notch mid-axillary line.
- Typically ranges from -2 to 6 mm Hg during normal inspiration and expiration.
ICP (Intracranial Pressure):
- ICP monitor provides direct measurement of intracranial pressure.
- Increased ICP can result from various insults including head injury, hypoxic brain damage, cerebral tumors, and surgical interventions.
- Symptoms may include changes in consciousness, compression of cranial nerves, variability in blood pressure and pulse, progressive muscle weakness, respiratory coordination difficulties, and cerebral rigidity.
- Involves positioning a hollow screw through the skull into the subarachnoid space, connected to a transducer and oscilloscope for continuous monitoring.
Chest Drainage and Fluid Collection System:
- Chest tubes are large catheters placed in the pleural cavity to evacuate fluid and air.
- Drained fluid and air collect into a graduated collection reservoir bedside.
- Common indications include pneumothorax and pleural effusion.
- Chest tubes are typically inserted into the 6th intercostal space in the mid or posterior axillary line.
Hemodynamic Monitoring:
- Measures the force involved in the circulation of blood.
- Can be performed using both invasive and non-invasive procedures.
- Hemodynamic stability depends on four parameters: heart rate, blood pressure, stroke volume, and cardiac output.
Biochemistry:
- Involves various tests such as:
- ABG (Arterial Blood Gas) analysis
- Blood glucose monitoring
- Liver functioning tests
- Renal functioning tests
- Hematology, including hemoglobin, platelet count, and coagulation tests
Microbiology:
- Includes:
- Sputum analysis
- Throat, nose, swab, and smear cultures
Blood Volume:
- Blood volume, cardiac function capacity, and colloidal osmotic pressure are of major importance in fluid therapy.
- Indirectly inferred from measurements including arterial blood pressure, heart rate, central venous pressure, urine output, hemoglobin concentration, and pulmonary artery occlusive pressure.
- Normal blood volume is 2.1371 m2 for females and 2.374 m2 for males.
Ventilatory Monitoring:
- This applies to incubated and mechanically ventilated patients, assessing airway pressure and patient outflow.
- Modern ventilators measure outflow volume.
- Evaluated parameters include:
- Oxygenation: Lung gas exchange, with adequate PaO2 and SaO2.
- Ventilation: Air pressure, respiratory quotient, and respiratory rate.
- Inspiratory to Expiratory Time Ratio.
- Dynamic pulmonary compliance curve derived from continuous airway pressure and volume measurements.
- Mechanical inspiratory strength is calculated as pressure against a closed airway.
- PEEP (Positive End-Expiratory Pressure) and CPAP (Continuous Positive Airway Pressure) are measured and adjusted using ventilatory settings as needed.
