Non-Invasive Cardiovascular

Monitoring

Dr. Koo Chi Kwan

Intensive Care Unit
Queen Elizabeth Hospital
 Non-invasive monitoring

 Definition
 Monitoring procedures or modalities that do not
involve breaching of the skin and/or mucosa
 Advantages

 Indicated for all patients

 Do not require sophisticated equipment
 Easy to set up
 Absence of major complications
 Limitations

 Low data reliability in sick patients

 Pulse oximetry, Non-invasive blood pressure
 Unable to obtain sophisticated data
 Cardiac output
 Indication

 All patients who need cardiovascular

monitoring
 Modalities

 Clinical Observations
 Pulse
 Blood pressure
 Electrocardiogram
 Pulse oximetry
 Clinical Observations

 General condition, mental state

 Dyspnoea, tachypnoea
 Capillary refill, peripheral circulation
 Jugular venous pressure(JVP)
 Pulse

 Rate
 Volume
 Character

Pulsus parvus,tardus, bisferiens,alternans,paradoxus…
 Pulse

 It has been used for thousands of years by

medical practitioners
 It requires no equipment
 It is applicable to all patients
 Pulse

 Limitations
 It is non-specific
 Wide inter and intra-observer variation
 Need good clinical experience
 Pulse

 Role
 Initial assessment of patient
 Peripheral vascular disease
 Post major vascular repair
 Blood Pressure

 Manual
 Oscillotonometry
Manual Blood Pressure
Manual Blood Pressure

Profile of Korotkoff
sound
 Manual Blood Pressure

 Korotkoff IV vs V sound
 Korotkoff IV is a better indication of diastolic pressure

according to theory
 However Korotkoff V is the commonly recommended

measuring point except in pregnant patients because

 It is associated with less inter-observer variations
 It is easier to detect by most observer
 Manual Blood Pressure

 Korotkoff sounds vs invasive blood pressure

 Korotkoff IV is on average 8mm Hg above the

invasively measured diastolic blood pressure

 Korotkoff V is on average 2mm Hg above the invasively

measured diastolic blood pressure

Blood Pressure - Oscillotonometry

Principle of Oscillotonometry
Blood Pressure - Oscillotonometry

Bleed
valve
artefact

Arterial
pulsation
Principle of Oscillotonometry
 Blood Pressure - Oscillotonometry

 Problem
 Bruises and Petechiae under the cuff
 Blood Pressure - Oscillotonometry

 Limitations
 Inaccurate / unreliable in shock patients

 Inaccurate / unreliable in patients with

arrhythmias
 The algorithm of measurement assumes a
regular pulse, so the reading is un-reliable in
patients with irregular pulse
 Blood Pressure - Oscillotonometry

 Interpretation
 Which of the 3 readings
 Systolic pressure
 Mean pressure

 Diastolic pressure

is most reliable ?
 Blood Pressure - Oscillotonometry

 Interpretation
 It was shown that the mean pressure
obtained by oscillotonometry correlates best
with other means of blood pressure
monitoring
 It is also the parameter that is most
reproducible.
 Electrocardiography

A standard ECG waveform

 Electrocardiography

 It provides information on
 Heart rate
 Atrial, ventricular
 Rhythm
 Status of myocardial oxygenation
 ST segment analysis
 Myocardial diseases
 Electrocardiography

 It also provides non-cardiac information

 Electrolyte disturbance
 Serum Potassium level affects the ECG in a
predictable and dose related manner
 Drug toxicity
 Digitalis, Tricyclic antidepressant, Anti-
cholinesterase…..
 Electrocardiography

 Limitations
 Single lead ECG may miss ischaemia in different
parts of the heart
 Little correlation with blood pressure or cardiac
output
 Wrong lead placement not uncommon
 EMG and AC power artifact
 Pulse Oximetry

 It is a continuous non-invasive method for

measuring
 Arterial oxygen saturation
 Pulse rate
 Pulse Oximetry

 Principle of operation - 1
 Infrared absorption by oxygenated and de-
oxygenated haemoglobin at 2 different
wavelengths
 Pulse Oximetry

 Principle of operation - 2
 Pulse Oximetry

 Principle of operation - 3 Wavelength of

infrared light emitted
by the 2 LEDs
 Pulse Oximetry

 Principle of operation - 4
 The success of pulse oximetry depends on its
ability to measure the saturation of the arterial
blood by analysis of infrared absorption of
vascular bed throughout the whole pulsatile
pulse cycle.
 Pulse Oximetry

 Principle of operation - 5

The variable absorption due to pulse added volume of arterial blood

is used to calculate the saturation of arterial blood
Pulse Oximetry- CVS monitoring

Normo-volaemic

Significant blood loss

After fluid replacement

 Pulse Oximetry

 Limitations
 Patient movement
 Ambient light
 Peripheral shut down
 Carbon monoxide poisoning
 In Summary

 Non-invasive cardiovascular monitoring

 Is indicated in all patients;
 Is the first line in monitoring of sick patients;
 Is associated with minimal complications;
 Yields valuable data provided that the limitations
are kept in mind