Respiratory monitoring

Abstract

Monitoring is essential to patient care in the intensive care unit. Although arterial blood gas analysis is often considered the gold standard for evaluation of gas exchange, blood gases may be used excessively in many intensive care units. Pulse oximetry is commonly used to assess arterial oxygenation in critically ill patients. Capnometry is useful to detect esophageal intubation, but use of end-tidal PCO2 as a noninvasive indicator of arterial PCO2 is often unreliable. Transcutaneous monitoring of PO2 and PCO2 is commonly used in the neonatal intensive care unit but not with critically ill adults. A wealth of information is provided by ventilator waveforms such as the risk of alveolar overdistension and the presence of auto-positive end-expiratory pressure. There has been increasing enthusiasm recently for the use of pressure-volume curves to properly set the ventilator.