Key result
Physiological monitoring during mechanical ventilation shows little evidence of affecting patient outcomes.
Despite the widespread adoption of various physiological monitoring techniques as standard of care during mechanical ventilation, there is a lack of evidence demonstrating that their use directly improves patient outcomes.
Questions routine monitoring during mechanical ventilation; leaves open whether any monitors improve outcomes in prospective trials.
Monitoring is a continuous, or nearly continuous, evaluation of the physiological function of a patient in real time to guide management decisions, including when to make therapeutic interventions and assessment of those interventions. Pulse oximeters pass two wavelengths of light through a pulsating vascular bed and determine oxygen saturation. The accuracy of pulse oximetry is about ±4%. Capnography measures carbon dioxide at the airway and displays a waveform called the capnogram. End‐tidal PCO2 represents alveolar PCO2 and is determined by the ventilation‐perfusion quotient. Use of end‐tidal PCO2 as an indication of arterial PCO2 is often deceiving and incorrect in critically ill patients. Because there is normally very little carbon dioxide in the stomach, a useful application of capnography is the detection of esophageal intubation. Intra‐arterial blood gas systems are available, but the clinical impact and cost effectiveness of these is unclear. Mixed venous oxygenation (PvO2 or SvO2) is a global indicator of tissue oxygenation and is affected by arterial oxygen content, oxygen consumption and cardiac output. Indirect calorimetry is the calculation of energy expenditure and respiratory quotient by the measurement of oxygen consumption and carbon dioxide production. A variety of mechanics can be determined in mechanically ventilated patients including resistance, compliance, auto‐peak end‐expiratory pressure (PEEP) and work of breathing. The static pressure‐volume curve can be used to identify lower and upper infection points, which can be used to determine the appropriate PEEP setting and to avoid alveolar overdistension. Although some forms of monitoring have become a standard of care during mechanical ventilation (eg, pulse oximetry), there is little evidence that use of any monitor affects patient outcome.
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Dean Hess (1996) conducted a review in Mechanical ventilation. Physiological monitoring was evaluated. Although some forms of monitoring are standard of care during mechanical ventilation, there is little evidence that the use of any monitor affects patient outcome.