Monitoring and Managing the Critically Ill Patient in the Intensive Care Unit

The need for better acquisition and monitoring of patient physiological information within and outside of healthcare settings is increasingly important as our healthcare system serves an ever-aging population of more critically ill patients. Monitors serve several purposes, including the identification of shock and abnormal cardiac physiology, evaluation of cardiovascular function, and/or to allow for optimizing titration of therapy. An important function of an effective monitoring device is the reliable detection of abnormal physiology. Despite much research on the uses of monitoring techniques in critical care, there is little evidence to support improved outcomes related to the routine uses of monitors. Mainstays of invasive monitoring in the intensive care unit (ICU), include central venous pressure monitoring and arterial pressure monitoring; with pulmonary arterial monitoring used less frequently. Recent trends in monitoring have included developments of less invasive monitoring techniques that yield a number of cardiovascular parameters potentially useful to clinicians. New noninvasive measures of tissue perfusion (e.g., sublingual capnometry and tissue hemoglobin saturation (StO2)) have significant potential for the identification and treatment of pathophysiologic states resulting in inadequate tissue perfusion. Developers of new monitors, despite facing regulatory requirements that are less stringent than those of drug manufacturers, will be expected to demonstrate the clinical efficacies of new devices. In the final analysis, the most important “monitor” is a critically thinking healthcare provider at the bedside carefully evaluating the patient’s response to intervention and therapy.