1. Perform a complete recruitment maneuver. 2. Determine a patient’s optimal positive end-expiratory pressure (PEEP) through determination of the PEEP of best compliance during a recruitment maneuver. 3. Perform calculations needed to monitor a patient’s oxygenation status. 4. Perform calculations needed to monitor a patient’s ventilation status. 5. Assist with chest tube placement. 6. Identify the indications for chest tube placement. 7. Perform monitoring techniques for the patient with a chest tube. Monitoring and management of a patient in the intensive care unit (ICU) requires the integration of all your respiratory care knowledge to successfully care for the patient. You will be measuring physiologic values, analyzing and interpreting these values, and then using the findings to manage your patient appropriately on the basis of all the information you gathered. Every cell in the body requires oxygen for metabolic activity. A patient’s oxygen consumption reveals information about how well the tissues are receiving, or not receiving, the oxygen that is transported by arterial blood. Because oxygen is delivered at the capillary level, comparing the blood oxygen content before and after a specific capillary describes how much oxygen is required by the tissue that is oxygenated by that capillary. Measuring oxygen consumption at this level is rather impractical; however, the average oxygen consumption for the whole body provides valuable information (Box 23-1). Information about the hemoglobin (Hb) level, mixed venous oxygen tension ( 1. Review the patient’s chart. 2. Verify the physician’s order or the facility’s protocol for standard of care. 3. Obtain, clean, and inspect the appropriate equipment prior to entering the patient’s room. 4. Follow personal protective equipment (PPE) requirements, and observe standard precautions for any transmission-based isolation procedure. 5. Identify the patient using two patient identifiers. 6. Introduce yourself to the patient and to the family. 7. Explain the procedure to the patient and to the family, and acknowledge the patient’s understanding. 8. Perform proper hand hygiene, and put on gloves, mask, and protective eyewear, as appropriate for procedure. 2. Observe for signs and symptoms of inadequate oxygenation. 3. Calculate oxygen consumption ( 6. Calculate oxygenation index (OI): 7. Remove the supplies from the patient’s room, and clean the area, as needed. 8. Remove PPE, and perform proper hand hygiene prior to leaving the patient’s room. Proper ventilation is central to the health of your patient. If your patient is not ventilating adequately, hypercapnia or hypocapnia could result. In either case, acid–base balance, and hemoglobin’s ability to transport oxygen are affected. As dead space volume increases, the amount of ventilation that a patient can perform decreases. Because dead space volume cannot be directly measured, it has to be indirectly measured by utilizing the Paco2 measurement from the ABG and the partial pressure of expired carbon-dioxide (Peco2) measurement from an end-tidal CO2 monitor. Other methods of monitoring adequate ventilation exist (Box 23-2). The dead space to tidal volume (VD / VT) ratio is a useful tool for monitoring ventilation and for determining how much tidal volume is participating in gas exchange. The VD : VT ratio is equivalent to the ratio of the gradient between the Paco2 and Peco2 to the Paco2 as shown below:
Monitoring and Management of the ICU Patient
Equipment
» Skill Check Lists
23-1 Monitoring Oxygenation
), and mixed venous oxygen saturation (SvO2) enables you to calculate venous oxygen content. Comparing this to the oxygen content of blood before the tissues (CaO2) and after the tissues (
) multiplied by the cardiac output allows the determination of the tissue oxygen consumption (
).
Procedural Preparation
Implementation
):
, partial pressure of 02 in venous blood
23-2 Monitoring Ventilation
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
Monitoring and Management of the ICU Patient
Reality Check Care of a patient in the ICU requires a team approach. Effective communication is imperative.
) mismatch is the primary cause of hypoxemia. The ratio’s reliability decreases as hypoventilation becomes the primary cause of hypoxemia.
). Both arterial and mixed venous blood samples are needed for measurement of physiologic shunt. Using the available data on oxygenation, understanding and interpreting the results, and knowing how to apply the findings to make decisions are all crucial in the care of the patient in the ICU. The following is the step-by-step process for monitoring oxygenation.
, O2 content of venous blood
