Physiologic Monitoring of the Surgical Patient
Physiologic Monitoring of the Surgical PatientNiccolo Horacio S.
Pozon, MDDepartment of SurgeryManilamedDetect pathological
variations in physiologic parametersTherapeutic interventionWhat is
the most important status to monitor?Oxygen to the microcirculation
for cellular aerobic metabolismHemodynamic MonitoringArterial Blood
PressureCardiac output and vascular impedance
ElectrocardiogramRate & rhythm abnormalities
Determined by parametersMeasured via approximation of those
parametersCardiac OutputPreloadEDV, CVP,
EDPAfterloadMAPContractilityend-systolic pressure-volume
lineDeterminants of Cardiac Performance
How are these parameters measured?Pulmonary Artery
CatheterPercutaneous 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 lineWhat
other monitoring methods are employed for hemodynamic
monitoring?Doppler ultrasoundImpedance cardiographyPulse contour
analysisPartial carbon dioxide rebreathingTransesophageal
echocardiographyAssessing Preload ResponsivenessNIRSHow do we
monitor the respiratory system?Oxygenation &
ventilationRespiratory SystemArterial blood gasVenous blood
gasWhich is more important to determine in the critically ill
patient? ABG or VBG?VBGIs there a role in measuring serum
lactate?Determinant of anaerobic metabolismPeak & plateau
airway pressurePulse oxymetryCapnographyDeterminants of oxygen
deliveryUrine outputIntake vs. outputRenal
MonitoringTriadOliguriaelevated peak airway pressureselevated
intra-abdominal pressureAbdominal Compartment SyndromeHow is
abdominal compartment syndrome diagnosed?Bladder pressure 20 mm Hg
recorded by three measurements 1 to 6 hours apart
Cerebral perfusion pressure (CPP)CPP = MAP ICPVentriculostomy
catheterNeurologic MonitoringEEG/Evoked potentialsLevel of
sedationBrainstem lesionsTranscranial doppler ultrasoundMiddle
& anterior cerebral artery flowJugular venous oxymetryNIRSBrain
tissue oxygen tension (?)THANK YOU!
