Core ICU continuous monitoring domains
Continuous ICU monitoring should support real-time detection of physiologic deterioration while nursing vigilance remains the basis of ICU care. [1] ICU continuous monitoring should include circulation monitoring, respiration monitoring, and oxygenation monitoring with continuous display and alarm capability where indicated. [1] A written monitoring plan should specify which physiologic observations are recorded and how often, accounting for diagnosis, comorbidities, and the treatment plan. [2]
Minimum physiologic observations for monitoring plans
Monitoring plans should include the following physiologic observations at initial assessment and as part of routine monitoring:
- Heart rate. [2]
- Respiratory rate. [2]
- Systolic blood pressure. [2]
- Level of consciousness. [2]
- Oxygen saturation. [2]
- Temperature. [2]
Continuous circulation monitoring components
Circulation should be monitored at frequent, clinically appropriate intervals by arterial pulse detection, electrocardiography display, and arterial blood pressure measurement. [1] ECG equipment should be available to monitor and continuously display electrocardiography for ICU patients. [1] Pressure monitoring equipment should monitor and continuously and simultaneously display arterial pressure, central venous pressure, and at least one additional pressure modality when required. [1]
Continuous respiratory and oxygenation monitoring components
Respiratory function should be assessed at frequent, clinically appropriate intervals with observation supported by capnography and blood gas analysis. [1] Oxygenation should be assessed at frequent, clinically appropriate intervals with observation supported by pulse oximetry and blood gas analysis. [1] Pulse oximetry capability should be available for every patient. [1] End-tidal CO2 monitoring (capnography) should be available at each bed and used to confirm tracheal tube placement immediately after insertion and continuously in ventilator-dependent patients. [1]
Continuous temperature monitoring components
ICU temperature monitoring should include capability to monitor central temperature and cutaneous temperature. [1]
Continuous mechanical ventilation monitoring components
When a ventilator is in use, ventilatory volumes should be measured as continuous monitoring when feasible. [1] Airway pressure and respiratory circuit pressure should be monitored continuously with prompt warning for excessive pressures. [1]
Continuous monitoring system requirements
Patient monitoring equipment should be modular with trending capability, visible and audible alarms, unobstructed display, alarm recording, and hard-copy capacity. [1] Networking capability and device uniformity with other hospital areas should be desirable to support continuity of monitoring. [1] Clinical monitoring equipment should include electrical safety design appropriate for ICU use. [1]
Monitoring for patient safety on ICU equipment
Piped gas supply failure alarms should be present. [1] Oxygen supply failure alarms should be fitted to ventilators to warn of low oxygen pressure. [1] Breathing system disconnection and ventilator failure should have devices capable of prompt warning when automatic ventilators are in use. [1] Oxygen analyzers should be available to measure delivered oxygen concentration from ventilators or breathing systems. [1]
Continuous monitoring intensity planning
Physiologic track-and-trigger systems should be used for monitoring and should define parameters measured and the frequency of observations. [2] Observation frequency should be at least every 12 hours unless a senior decision changes the frequency for an individual patient. [2] The frequency of monitoring should increase when abnormal physiology is detected. [2] Additional monitoring should be considered in specific clinical circumstances, including hourly urine output and biochemical analysis such as lactate, blood glucose, base deficit, and arterial pH. [2]