Monitoring device

Cerebral & renal somenetics

  • Measures tissue perfusion and oxygen delivery by infrared spectroscopy
  • Helpful to assess trends and adequacy of cardiac output
  • Useful for post op hearts and children in shock

End Tidal CO2 Monitor

End tidal CO2 monitor

  • Monitor CO2 level when mechanically ventilated without drawing blood gases
  • Need to ensure that the level does correlate with a blood gas initially!
  • Helps to detect dead space ventilation/ET tube obstruction
    • ***Unreliable in presence of air leak!!!
     

Pulse oximetry

Pulse oximetry

  • Monitors systemic oxygen saturation
  • Needs adequate tissue perfusion to be reliable
  • Ensure good waveform before interpreting the saturation
  • Unreliable in CO and Met Hb poisoning (low PaO2 with normal sat)
  • Inability to pick up sats suggests decreased tissue perfusion

ICP Monitoring

ICP monitoring

  • Indicated in patients with concerns about elevated intracranial pressure
  • Normal ICP:0-10 mmHg, ICP > 20 is abnormal and needs to be treated
  • Ensure device leveled accurately
  • Ensure good waveform before interpreting and reacting to pressures
    • ***Pressure spikes that go up and stay up are of most concern and need treatment!
     
  • Different devices available as shown in picture (subdural bolts and ventriculostomy are most common in our PICU)
  • Cerebral perfusion pressure (CPP) = Mean arterial pressure (MAP) – ICP Goal is > 50 for infants, > 60 for most children, > 70 for adults

Telemetry

  • Continuous ECG monitoring allows for assessment of heart rate and rhythm, ischemia and conduction defects