intensive care unit

1. Noninvasive monitoring
in critical ill patient

2. Learning objectives
 Know the different noninvasive techniques used in ICU
 Know the different technologies used in noninvasive monitoring
 Know the advantage of theses different noninvasive methods

3. Who needs physiologic monitoring ?

4. ……
 Patients with unstable physiologic regulatory system
 Patients with a suspected life threatening conditions
 Patients with a high risk of developing life
threatening conditions
 Patients in critical physiologic state [

5. Basic monitoring
 Vital signs ….***
 Cardiac– BP,HR,ECG,jvp,CO
 Respiratory—
airway pressure,capnogram,
pulse oximetry, spirometry
 Neurologic---
loc, pupil size,cpp,icp
 Temperature
 Urine output
 Weight gain /3rd spacing??/
 Capillary refill
 Visual surveillance

6. What should be monitored in critical ill
patients??
 Circulation
 Ventilation
 Oxygenation
 maintain adequate tissue perfusion with oxygenated
blood]

7. How to monitor circulation?

 Noninvasive BP
 HR, Pulses ECG,,Echo
 Mental status
 Skin temperature
 Capillary refill
 Urine output:
imp. Measurements in hemodynamically unstable
patients…….
Noninvasive hemodynamics monitoring

8. *Palpation and auscultation,,precordium
*arrhythmias, hypokalemia ,,,ECG
*Blood pressure
 Doppler ultrasound detector
 Automated oscillometric device

10. …other Tools used recently in
noninvasive co monitoring
 Partial gas rebreathing
 Thoracic bioimpedence
 Thoracic biorectance
 ECOM
 Portable Doppler device
 Photoelectric plethysmography

11. How to monitor oxygenation?
 Blood gas analysis/ pao2/
 Pulse oximetry /sao2/
 Oxyhemoglobin saturation
 Hemoxiymetry
 Oxyhemoglobin
 Met hemoglobin
 Carboxyhemoglobin
 “the concept of oxygen delivery “……

12.  Noninvasive monitoring of oxygen delivery in critical ill
patient
1. Hypovolemia
2. Anemia
3. Hypoxemia
 Noninvasive monitoring of oxygen
 Oxygen saturation/spo2/
 Oxygen reserve index /ORI/
 Hemoglobin concentration/spHb/

13. How to monitor ventilation?
 Arterial blood gas
 Paco2,pao2
 Capnography
 End tidal co2
 Respiratory rate
 Respirometry
 Tidal volume ,minute volume

14. o Objective method to measure patients peripheral
perfusion
o Early indicator of deterioration
 Lactic acid
 Hypoperfusion severity index
 >15 is fatal
 Normal lactate <2…concerned>4

15. Noninvasive tissue perfusion device ….
 Capnography
 Carbondyoxide clearance reflects perfusion
 Available for intubated and nonintubated patients
 end tidal co2/ETco2
 2-5mmhg difference between the ETco2 and Paco2 in
patients with a healthy lung
Wider difference in:
 Abnormal perfusion and ventilation
 Incomplete alveolar opening
 Poor sampling

16. Less invasive =less complex

18. Thank you!