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Criticare - A special feature on Anaesthesiology
Long period of monitoring in ICU
Dr Omender Singh
There are at least four categories of patients who need ICU
monitoring, which may sometimes stretch to a month.
1. Patients with unstable physiologic regulatory systems. For instance, a patient
whose respiratory system is suppressed by a drug overdose or anaesthesia.
2. Patients with a suspected life threatening condition. This is when a patient
who has findings, indicating an acute myocardial infarction heart attack.
3. Patients at high risk of developing a life–threatening condition. For
instance, patients immediately post open-heart surgery.
4. Patients in a critical physiological state. For instance,
patients with multiple trauma or septic shock.
Monitoring in ICU helps critical care physicians in diagnosis
of life threatening problems, ie cardiac arrhythmias so that life saving therapy
can be appropriately applied. Monitoring system also has alarms for different
grades of problems. Mentor also provides data storage of vital parameters of
long duration of monitoring in ICU, which can be analysed any time.
Preanaesthetic assessment and premedicationPatient safety
can be achieved by application of practice standards, monitoring techniques,
proper preoperative evaluation, anaesthtic plan and postoperative care.
Detailed preanaesthetic check up helps the anaesthetist to check the patient’s
preoperative preparations, assess physical and psychological state, to request
any further investigations, he/ she may consider essential to decide what technique
to use and the method of postoperative analgesia.
Proper premedication entails the use of pharmacological agents to attain specific
responses in patients presenting for surgery, like allay anxiety, induce sedation,
promotion of haemodynamic stability and minimise chances of aspiration of acid
gastric contents. In one American study, 20 per cent of the patients arriving
to the operation theatre had evidence of myocardial ischaemia.
Proper preanaesthetic medication and counselling can significantly reduce this
and in turn reduce the incidence of perioperative myocardial infarction in patients
with coronary artery disease, undergoing cardiac / non cardiac surgery.Long
period of monitoring in ICU is very helpful in:
1. To function as a decision- making tool that health professionals may use
in planning then care of critically ill patients.
2. To measure the severity of illness for patient classification purposes.
3. To analyse the outcomes of ICU care in terms of clinical effectiveness cost-effectiveness.
“A tertiary care hospital is good if these two departments are well equipped
and well managed.”
The writer is consultant intensivist, Escorts Hospital &
Research Centre, Faridabad
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