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:
- 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.
- Intensive care management of coronavirus disease 2019 (COVID-19): challenges and recommendations. Lancet Respir Med. 2020 Apr 6. pii: S2213-2600(20)30161-2.
- 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.
- Bedside echocardiographic evaluation of hemodynamics in sepsis: is a qualitative evaluation sufficient? Intensive Care Med. 2006 Oct;32(10):1547-52.
- Less invasive hemodynamic monitoring in critically ill patients. Intensive Care Med. 2016 Sep;42(9):1350-9.
- Point-of-care lung ultrasound in patients with COVID-19 – a narrative review. Anaesthesia. 2020 Apr 10.
- Ten good reasons why everybody can and should perform cardiac ultrasound in the ICU. Anaesthesiol Intensive Ther. 2014 Nov-Dec;46(5):319-22.
