You are on page 1of 2

Monitoring the critically ill patient

Table 1: Twelve physiological variables measured in the acute physiological portion of the APACHE II(Acute Physiological Score) scoring system
1. 2. 3. 4. Temperature - core Mean arterial pressure Heart rate Respiratory rate - ventilated or non-ventilated Oxygenation FIO2 > 0.5 record A-aDO2 FIO2 < 0.5 record PaO2 Arterial pH Serum sodium Serum potassium Serum creatinine Haematocrit White blood cell count Glasgow coma score

5.
6. 7. 8. 9. 10. 11. 12.

This not only allows the assessment of the physiological reserve of the patient but will also give a baseline against which the effectiveness of any applied treatment can be judged.

THE PHYSIOLOGICAL RESPONSES TO STRESS AND TRAUMA patients are typically febrile, hypertensive, with a tachycardia(increase catecholamines) and tachypnoea. Urine output is often diminished early after trauma or operation because of hypovolaemia, a decrease in renal blood flow, and a hormonal milieu that leads to sodium and water reabsorption.

MEASUREMENT OF ADEQUACY OF TISSUE OXYGENATION - Decrease O2 = cellular injury (Low blood flow states, microcirculatory failure and endotoxaemia) In practice this approach can only be applied to a limited number of organs where the relevant blood samples can be taken - these include the lung (systemic artery versus pulmonary artery), the liver (systemic artery versus hepatic vein) and the brain (systemic artery versus jugular bulb).

CARDIOVASCULAR SYSTEM MONITORING

Temperature - by vasoconstriction and low cardiac output. Electrocardiogram (ECG) - provides useful information about ischaemia, arrhythmias, electrolyte imbalance and drug toxicity. Pulse Oximetry - In healthy patients the pulsatile component of the signal is only around 2% of the total absorption making the signal to noise ratio of the measurement poor. At low haemoglobin levels the measurement becomes unreliable. Haematocrit and Haemoglobin Concentration - Low haematocrit tends to be associated with improved peripheral perfusion because of decreased viscosity -although the exact contribution of this fact to the perfusion in the patient is largely unknown, since much of this hypothesis is based on what happens in glass capillary tubes rather than small blood vessels. However, there may be compromised tissue oxygen delivery due to decreased oxygen carrying capacity. Serial decline in haematocrit indicates continued bleeding, but haemodilution with crystalloids can also result in a fall in the haematocrit. The percentage of red cells present in a blood sample gives an indication of adequacy of blood replacement following trauma and surgery. In the critically ill patient an ideal haematocrit is probably 35%, with a haemoglobin concentration of 12-14 g/dl.

You might also like