INTENSIVE CARE
Posted by admin on November 18th, 2009Monitoring all physiologic functions is essential during the patient’s stay in the intensive care unit. Pulse, blood pressure, temperature, res¬piratory rate and depth, and state of consciousness must be measured and recorded on flow charts. Hourly urine output should also be noted. Central venous pressure must be monitored when oligemia or fluid de¬pletion requires that large volumes of fluid be administered, particu¬larly when cardiac or pulmonary reserve is limited. Also, a postopera-
live ECG should be recorded; if necessary, another ECG may be recorded later. Chest x-rays should be taken immediately after the op¬eration and then daily. If cardiorespiratory problems are present, the usual laboratory studies of blood and blood chemistry must be supple¬mented with arterial blood gas determinations.
At limes, additional monitoring may be required. For example, arte¬rial catheters may remain in place for days or weeks to obtain direct blood pressure measurements. Such a catheter must he observed fre¬quently to make sure that it has not been dislodged and that circulation to the fingers has not been compromised. When the right ventricular pressure reading obtained by central venous pressure monitoring docs not adequately reflect left ventricular pressure, a pulmonary artery (Swan-Ganz) catheter may be inserted in the operating room or the in¬tensive care unit. Such a situation may occur with severe pulmonary artery disease, severe left ventricular failure related to ischemia, or other diseases associated with significant pulmonary hypertension. The data obtained by the pulmonary artery catheter help maintain ade¬quate blood volume and determine physiologic treatment of the pa¬tient’s cardiac inotropic stale and peripheral vascular resistance.
