title: Monitoring in the intensive care.
abstract: In critical care, the monitoring is essential to the daily care of ICU patients, as the optimization of patient's hemodynamic, ventilation, temperature, nutrition, and metabolism is the key to improve patients' survival. Indeed, the decisive endpoint is the supply of oxygen to tissues according to their metabolic needs in order to fuel mitochondrial respiration and, therefore, life. In this sense, both oxygenation and perfusion must be monitored in the implementation of any resuscitation strategy. The emerging concept has been the enhancement of macrocirculation through sequential optimization of heart function and then judging the adequacy of perfusion/oxygenation on specific parameters in a strategy which was aptly coined "goal directed therapy." On the other hand, the maintenance of normal temperature is critical and should be regularly monitored. Regarding respiratory monitoring of ventilated ICU patients, it includes serial assessment of gas exchange, of respiratory system mechanics, and of patients' readiness for liberation from invasive positive pressure ventilation. Also, the monitoring of nutritional and metabolic care should allow controlling nutrients delivery, adequation between energy needs and delivery, and blood glucose. The present paper will describe the physiological basis, interpretation of, and clinical use of the major endpoints of perfusion/oxygenation adequacy and of temperature, respiratory, nutritional, and metabolic monitorings.
authors.affiliation: Department of Anesthesiology and Critical Care, Lille University Teaching Hospital, Rue Michel Polonowski, 59037 Lille, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Kipnis
authors.forename: Davinder
authors.initials: D
authors.lastname: Ramsingh
authors.forename: Maneesh
authors.initials: M
authors.lastname: Bhargava
authors.forename: Erhan
authors.initials: E
authors.lastname: Dincer
authors.forename: Maxime
authors.initials: M
authors.lastname: Cannesson
authors.forename: Alain
authors.initials: A
authors.lastname: Broccard
authors.forename: Benoit
authors.initials: B
authors.lastname: Vallet
authors.forename: Karim
authors.initials: K
authors.lastname: Bendjelid
authors.forename: Ronan
authors.initials: R
authors.lastname: Thibault