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Physiologic Monitoring of

the Surgical Patient


Niccolo Horacio S. Pozon, MD
Department of Surgery
Manilamed

Detect pathological variations in physiologic


parameters
Therapeutic intervention

What is the most important status to


monitor?

Hemodynamic Monitoring
Oxygen to the microcirculation for cellular
aerobic metabolism

Arterial Blood Pressure


Cardiac output and
vascular impedance

Electrocardiogram

Rate & rhythm


abnormalities

Cardiac Output
Determined by parameters
Measured via approximation of those
parameters

Determinants of Cardiac
Performance
Preload
EDV, CVP, EDP

Afterload
MAP

Contractility
end-systolic pressure-volume line

How are these parameters measured?

Pulmonary Artery
Catheter

Percutaneous CVP Line

PAC

Which is more superior in terms of outcome?


PAC or CVP line?

PAC is associated with more complications


compared to a CVP line

What other monitoring methods are


employed for hemodynamic monitoring?

Doppler ultrasound
Impedance cardiography
Pulse contour analysis
Partial carbon dioxide rebreathing
Transesophageal echocardiography

Assessing Preload Responsiveness


NIRS

How do we monitor the respiratory system?

Respiratory System
Oxygenation & ventilation

Arterial blood gas


Venous blood gas

Which is more important to determine in the


critically ill patient? ABG or VBG?

VBG

Is there a role in measuring serum lactate?

Determinant of anaerobic metabolism

Determinants of oxygen
delivery
Peak & plateau airway pressure
Pulse oxymetry
Capnography

Renal Monitoring
Urine output
Intake vs. output

Abdominal Compartment
Syndrome
Triad
Oliguria
elevated peak airway pressures
elevated intra-abdominal pressure

How is abdominal compartment syndrome


diagnosed?

Bladder pressure
20 mm Hg recorded by three measurements
1 to 6 hours apart

Neurologic Monitoring
Cerebral perfusion pressure (CPP)
CPP = MAP ICP
Ventriculostomy catheter

EEG/Evoked potentials
Level of sedation
Brainstem lesions

Transcranial doppler ultrasound


Middle & anterior cerebral artery flow

Jugular venous oxymetry


NIRS
Brain tissue oxygen tension (?)

THANK YOU!