Monitoring


Oxygenation
  • Pulse Ox (not accurate in CO poisoning) ABG PaO2, Sat
Ventilation:
  • Capnography
  • PaCO2
  • HCO3
  • PH
 
CVP 
  • Central venous pressure (normal 5-12 cm H2O) - can be used to monitor perfusion
  • Goal:
    • Off Vent 8-12 desired in sepsis
    • On Vent: 12-15
       
  • CVP is elevated by :
    • Hypervolemia
    • forced exhalation
    • Tension pneumothorax
    • Heart failure
    • Pleural effusion
    • Decreased cardiac output
    • Cardiac tamponade
    • Mechanical ventilation and the application of positive end-expiratory pressure (PEEP)
    • Pulmonary Hypertension
    • Pulmonary Embolism
       
  • CVP decreases with:
    • Hypovolemia
    • Deep inhalation
    • Distributive shock
       
  • The CVP catheter is also an important treatment tool which allows for:
    • Rapid infusion
    • Infusion of hypertonic solutions and medications that could damage veins
    • Serial venous blood assessment
MAP (Mean Arterial Pressure):
  • > 65 desired in EGDT/sepsis.
  • 60 required for Cerebral & Renal perfusion
  • MAP = [(2X DPP)+SPB] / 3


 

Urine Output:
  • Normal : 1 - 2.4 L/Day -OR-  0.5 mL/kg/hr
    •  Oliguric < 30cc/hr
    • Monitor with Foley.
  • Remove ASAP to prevent CAUTI
Fluid Balance:
  • Daily weights