Monitoring
Non-invasive Monitoring
Monitoring
the temperature, respiratory rate and effort, heart rate and rhythm (ECG), BP, oxygenation, cognitive status, fluid intake and output, and peripheral perfusion
is mandatory. Evaluate the patient’s signs and symptoms daily for correction of
fluid overload. A pulse oximeter should be used continuously in any unstable
patient who is on O2 therapy. Transcutaneous arterial O2
saturation monitoring is recommended for patients on O2 therapy and
ventilatory support. Venous blood gas may be used as an alternative to arterial
blood gas if the risk of vascular injury is present. Acid-base balance should
also be checked on admission in cases of acute pulmonary edema or prior history
of chronic obstructive pulmonary disease. While admitted in the hospital,
patient monitoring should also include daily measurement of the weight, renal function,
and electrolytes.
Invasive Monitoring
Invasive hemodynamic monitoring is indicated for patients with
respiratory distress or signs of hypoperfusion when clinical evaluation is
insufficient to accurately assess intracardiac filling pressures.
Intra-arterial Line
Insertion of an intra-arterial line should only be considered in patients with low SBP and persistent heart failure despite treatment (eg cardiogenic shock).
Central Venous Line
Multiple lumen catheters are useful for fluid and drug administration and monitoring of the central venous pressure and venous O2 saturation, which provides an estimate of the body O2 consumption/delivery ratio.
Pulmonary Artery Catheterization
Pulmonary artery catheterization measures the cardiac output and superior vena, right atrium, right ventricle, and pulmonary artery pressures. This can be used to identify the etiology of hypotension or end-organ dysfunction in patients with cardiogenic shock unresponsive to empiric initial shock management and to distinguish between a cardiogenic and non-cardiogenic mechanism in patients with concurrent cardiac and pulmonary disease. This should not be routinely performed in hemodynamically stable patients with acute heart failure. This should only be considered in patients who are refractory to pharmacological therapy, persistently hypotensive, have uncertain left ventricular filling pressure or are being considered for surgery.