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Critical Care Research and Practice
Volume 2012 (2012), Article ID 473507, 20 pages
http://dx.doi.org/10.1155/2012/473507
Review Article

Monitoring in the Intensive Care

1Department of Anesthesiology and Critical Care, Lille University Teaching Hospital, Rue Michel Polonowski, 59037 Lille, France
2Department of Anesthesiology and Perioperative Care, University of California Irvine, Irvine, CA 92697, USA
3Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN 55455, USA
4Geneva Medical School, 1211 Geneva 14, Switzerland
5Centre de Recherche en Nutrition Humaine Auvergne, UMR 1019 Nutrition Humaine, INRA, Clermont Université, Service de Nutrition Clinique, CHU de Clermont-Ferrand, 63009 Clermont-Ferrand, France
6Intensive Care Division, Geneva University Hospitals, 1211 Geneva 14, Switzerland

Received 7 May 2012; Accepted 21 June 2012

Academic Editor: Daniel De Backer

Copyright © 2012 Eric Kipnis et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

In critical care, the monitoring is essential to the daily care of ICU patients, as the optimization of patient’s hemodynamic, ventilation, temperature, nutrition, and metabolism is the key to improve patients' survival. Indeed, the decisive endpoint is the supply of oxygen to tissues according to their metabolic needs in order to fuel mitochondrial respiration and, therefore, life. In this sense, both oxygenation and perfusion must be monitored in the implementation of any resuscitation strategy. The emerging concept has been the enhancement of macrocirculation through sequential optimization of heart function and then judging the adequacy of perfusion/oxygenation on specific parameters in a strategy which was aptly coined “goal directed therapy.” On the other hand, the maintenance of normal temperature is critical and should be regularly monitored. Regarding respiratory monitoring of ventilated ICU patients, it includes serial assessment of gas exchange, of respiratory system mechanics, and of patients' readiness for liberation from invasive positive pressure ventilation. Also, the monitoring of nutritional and metabolic care should allow controlling nutrients delivery, adequation between energy needs and delivery, and blood glucose. The present paper will describe the physiological basis, interpretation of, and clinical use of the major endpoints of perfusion/oxygenation adequacy and of temperature, respiratory, nutritional, and metabolic monitorings.