The main objective of monitoring in an intensive care and in medicine in general consists in increase in patient safety and in increase in quality of management of process of treatment. Special attention to issues of monitoring is connected with it in recent years that is confirmed by significant growth in publications on this problem. Along with issues of invasive monitoring which represents techniques, rather exact, but also more dangerous on number of possible complications, understanding of opportunities of noninvasive monitoring as more widespread in view of the relative simplicity and smaller intervention in the patient's organism is of great importance for specialists.
According to numerous publications, the ideal method of hemodynamic monitoring has to allow to estimate key indicators for correction of an intensive care, to provide the exact and reproduced measurements, to be easy in use, to be available to most institutions, not to depend on skills of the operator using this method, to possess fast time of the response to change of a condition of an organism of the patient and also not to cause complications and to be profitable. It is absolutely clear that such method of monitoring does not exist now and all others only in a varying degree partially correspond to the listed criteria. A considerable lack of invasive hemodynamic monitoring is the possibility of development of complications (including very heavy) and also high cost and inaccessibility of monitoring of this type to small institutions. The last is connected with the high cost of monitors for expanded hemodynamic monitoring and expendables.
Stages of monitoring include actually measurement of necessary parameters, diagnostics and decision-making and also timely correction of disturbances and assessment of efficiency of treatment.
Noninvasive monitoring of a hemodynamics includes obligatory for each patient who is in office of anesthesiology and resuscitation, measurement:
● Monitoring of an ECG (II, V5 and analysis of a segment of ST)
● Noninvasive arterial blood pressure
● Pulsoksimetriya (SpO2 and fotopletizmografiya)
In a form and amplitude of the photoplethysmogram calculation of the so-called perfusion index which reflects blood supply of peripheral fabrics and partly a condition of a sympathoadrenal system is possible. For carrying out calculation of this index it is important to observe all necessary requirements and to exclude external influences on a peripheral blood stream, such as mechanical prelum of vessels, the high or low ambient temperature, influence of medicines and so on. The perfusion index depends on a stroke output, a vascular tone and temperature of integuments. Considerable rejections of the perfusion index, its too high or too low values matter. The perfusion index correlates with some indicators of metabolism (lactate), it has also predictive value. Besides, the answer to some components of an intensive care, such as infusional therapy and use of inotropic means helps to estimate this indicator.
Measurement of noninvasive arterial blood pressure is very widespread not only in intensive care units and resuscitation, but also in offices of the general profile, at a pre-hospital stage. The method is attractive by the simplicity, not invasiveness, but has the certain errors connected with the technique of measurement (especially if it is carried out by the operator manually or by means of the monitor without observance of the technology of measurement). It is necessary to consider that figures of noninvasive arterial blood pressure at approach to critical values (both in one, and in other party) can differ from real considerably. For example, at the expressed hypotension overestimate of real indicators, and against the background of essential hypertensia — understating is observed. Frequency of development of the pathology connected with the low level of arterial blood pressure (an acute renal failure) is higher when using noninvasive techniques of measurement of the ABP. Lethality at shock is also higher at its correction based on measurements of noninvasive arterial blood pressure.
Also treat noninvasive monitoring a transthoracic and chrespeshchivodny echocardiography. It allows to estimate such parameters as final systolic and diastolic volumes, fraction of emission, pulmonary pressure, to find sites of dyskinesia and an akineziya of a myocardium, to diagnose pathology of the valve device of heart. Also by means of this technique it is possible to diagnose a cardiac tamponade in due time. The fact that it demands existence of the special equipment and also strong dependence of results of a research on skills of the operator belongs to shortcomings of this technique.