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Monitoring COVID-19 ICU Patients

Read about monitoring COVID-19 on ICU Patients

Neurology monitoring

Warning signs

Low level of consciousness index

Suggestion

Consider decreasing sedation

Respiratory monitoring

Warning signs

SpO2 < 92%

Suggestion

Consider increasing FiO2 or PEEP and prone positioning

Warning signs

Tidal volume > 8 ml/kg

Suggestion

Reduce tidal volume

Warning signs

Plateau pressure > 30 cm H2O

Suggestion

Consider reducing tidal volume and reducing PEEP

Swan Ganz catheter

Warning signs

Elevated pulmonary artery occlusion pressure (PAOP)

Suggestion

Consider fluid restriction, diuretics or ultrafiltration (if RRT)

Warning signs

Elevated pulmonary artery pressure (PAP)

Suggestion

Check right ventricular function

Warning signs

Low cardiac output (CO)

Suggestion

Check right and left ventricular function and consider fluid or inotropes

Warning signs

Low venous oxygen saturation (SvO2)

Suggestion

Check SaO2, cardiac output and hemoglobin

Arterial access

Warning signs

Hypoxemia

Suggestion

Consider increasing FiO2 or PEEP and prone positioning

Warning signs

Hypotension

Suggestion

Check cardiac function, fluid responsiveness and consider vasopressors, fluid, inotropes or decreasing PEEP

Warning signs

Large pulse pressure variation (PPV)

Suggestion

Careful with PEEP, diuretics and ultrafiltration (if RRT) and consider fluid if shock

Warning signs

Low CO (PiCCO) (Femoral only)

Suggestion

Check right and left ventricular function and consider fluid or inotropes

Warning signs

Elevated EVLW (PiCCO) (Femoral only)

Suggestion

Consider fluid restriction, diuretics or ultrafiltration (if RRT)

Central venous access

Warning signs

Low central venous oxygen saturation (ScvO2)

Suggestion

Check SaO2, cardiac output and hemoglobin

Warning signs

Elevated central venous pressure (CVP)

Suggestion

Check right ventricular function

ECG monitoring

Warning signs

Arrhythmia

Suggestion

Check electrolytes and consider decreasing cathecholamines

Warning signs

ST elevation

Suggestion

Check ECG, troponin and contact cardiologist

Warning signs

Increase QT interval

Suggestion

Perform 12-lead resting ECG and consider iatrogenicity, possibly decrease/stop QT-prolonging drugs

Ultrasound evaluation

Warning signs

B lines

Suggestion

Caution with intravenous fluid administration, consider diuretics or ultrafiltration (if RRT)

Warning signs

Lung consolidation

Suggestion

Follow up examination may be used instead of frequent chest X-rays

Warning signs

Lack of pleural sliding

Suggestion

Consider further evaluation to rule out barotrauma pneumothorax in appropriate clinical settings

Warning signs

LV systolic dysfunction

Suggestion

Consider inotropes

Warning signs

RV dilation

Suggestion

Consider inotropes or decreasing PEEP

Warning signs

Large inferior vena cava (IVC) respiratory variations

Suggestion

Careful with PEEP, diuretics and ultrafiltration (if RRT) and consider fluid if shock

Warning signs

Low VTI

Suggestion

Check right and left ventricular function and consider fluid or inotropes

 

NOTE: This is a selection of the most frequently used clinical variables by clinicians in the acute phase of this disease. This is not meant to be an exhaustive checklist.

References:

  1. Surviving Sepsis Campaign: Guidelines on the Management of Critically Ill Adults with Coronavirus Disease 2019 (COVID-19). Crit Care Med. 2020 Mar 27. doi: 10.1097/CCM. 
  2. Intensive care management of coronavirus disease 2019 (COVID-19): challenges and recommendations. Lancet Respir Med. 2020 Apr 6. pii: S2213-2600(20)30161-2. 
  3. Consensus on circulatory shock and hemodynamic monitoring. Task force of the European Society of Intensive Care Medicine. Intensive Care Med. 2014 Dec;40(12):1795-815. 
  4. Bedside echocardiographic evaluation of hemodynamics in sepsis: is a qualitative evaluation sufficient? Intensive Care Med. 2006 Oct;32(10):1547-52. 
  5. Less invasive hemodynamic monitoring in critically ill patients. Intensive Care Med. 2016 Sep;42(9):1350-9. 
  6. Point-of-care lung ultrasound in patients with COVID-19 – a narrative review. Anaesthesia. 2020 Apr 10. 
  7. Ten good reasons why everybody can and should perform cardiac ultrasound in the ICU. Anaesthesiol Intensive Ther. 2014 Nov-Dec;46(5):319-22.
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  • Intensive care
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