Physiologic Monitoring of

the Surgical Patient

Niccolo Horacio S. Pozon, MD
Department of Surgery
Manilamed

 Detect pathological variations in physiologic

parameters
Therapeutic intervention

 What is the most important status to

monitor?

Hemodynamic Monitoring
Oxygen to the microcirculation for cellular
aerobic metabolism

Arterial Blood Pressure

Cardiac output and
vascular impedance

Electrocardiogram

Rate & rhythm

abnormalities

Cardiac Output
Determined by parameters
Measured via approximation of those
parameters

Determinants of Cardiac
Performance
Preload
EDV, CVP, EDP

Afterload
MAP

Contractility
end-systolic pressure-volume line

 How are these parameters measured?

Pulmonary Artery
Catheter

Percutaneous CVP Line

PAC

 Which is more superior in terms of outcome?

PAC or CVP line?

 PAC is associated with more complications

compared to a CVP line

 What other monitoring methods are

employed for hemodynamic monitoring?

Doppler ultrasound
Impedance cardiography
Pulse contour analysis
Partial carbon dioxide rebreathing
Transesophageal echocardiography

 Assessing Preload Responsiveness

NIRS

 How do we monitor the respiratory system?

Respiratory System
Oxygenation & ventilation

 Arterial blood gas

Venous blood gas

 Which is more important to determine in the

critically ill patient? ABG or VBG?

 VBG

 Is there a role in measuring serum lactate?

 Determinant of anaerobic metabolism

Determinants of oxygen
delivery
Peak & plateau airway pressure
Pulse oxymetry
Capnography

Renal Monitoring
Urine output
Intake vs. output

Abdominal Compartment
Syndrome
Triad
Oliguria
elevated peak airway pressures
elevated intra-abdominal pressure

 How is abdominal compartment syndrome

diagnosed?

 Bladder pressure
20 mm Hg recorded by three measurements
1 to 6 hours apart

Neurologic Monitoring
Cerebral perfusion pressure (CPP)
CPP = MAP ICP
Ventriculostomy catheter

 EEG/Evoked potentials
Level of sedation
Brainstem lesions

Transcranial doppler ultrasound

Middle & anterior cerebral artery flow

Jugular venous oxymetry

NIRS
Brain tissue oxygen tension (?)

THANK YOU!