ICU devices & monitoring

RASS

measures the level of agitation or sedation of a pt

subjective measurement

bispectral index

• used to measure consciousness/sedation

• measure muscular and cortical activity

• objective measure

CAM-ICU

assess for delirium

• CAM + → delirium

• CAM - → delirium

arterial line

• provides continuous BP monitoring via cannulation of peripheral artery

indications

• need for continuous BP

• frequent analysis of ABGs or labs

DO NOT WB through wrist or have much wrist motion

pulmonary artery catheter

swan-ganz catheter

directly measures

• central venous pressure → normal = 2-6 mmHg

• Right atrium pressure → normal = 0-8 mmHg

• pulmonary artery pressure

  • normal = 15-30/5-15 mmHg

  • mean = 10-20 mmHg

• cardiac output → normal = 4-8 L/min

• mixed venous oxygen saturation (SvO2) → normal 65-70%

  • if lower then precaution for exercise

capnography

• assesses ventilation

• measures amount of CO2 in exhaled breaths

• End-tidal carbon dixoide (ETCO2)

  • normal = 35-45 mmHg

  • hypoventilation = >45

  • hyperventilation = <35

mechanical ventilator

• provides external ventilatory support

• requires and artificial airway

types: (from more to less support)

• Assist control

• SIMV

• CPAP

intra aortic balloon pump

• used for pts with cardiogenic shock

• catheter + balloon is inserted into large artery into descending aorta

inflates → diastole

deflates → systole

decreased afterload

increases coronary blood flow

DO NOT flex hip past 30!!!!

ECMO

temporarily takes over function of heart/lungs

ICU acquired weakness

clinically detectable weakness that has no other cause; diffuse; symmetrical

• often develops after 5-6 days in ICU

• effects peripheral & respiratory muscles

• common in pt on mechanical ventilator >7 days

risks

• increased mortality

• increased swallowing problems