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Category: Critical Care Nursing Careful clinical examination should be performed in the early phase of shock, as it can provide useful information about the causative mechanism. Pa...
Category: Critical Care Nursing Tachypnea is often the earliest sign of impending respiratory failure, even when arterial blood gases remain within normal limits. This may reflect...
Category: Critical Care Nursing Dead-space ventilation, the portion of tidal volume that does not encounter perfused alveoli, directly affects CO2 excretion and is used as an indi...
Category: Critical Care Nursing Tissue oxygenation depends on the delivery of oxygenated blood (both dissolved and bound to hemoglobin). The PaO2 is the partial pressure of oxygen...
Category: Critical Care Nursing Insertion of an arterial catheter has been recommended in patients with shock. In addition to providing real-time accurate measurement of arterial b...
Category: Critical Care Nursing Increased respiratory resistance may occur in the case of COPD or asthma, a narrow endotracheal tube, excessive secretions, use of a heat and moist...
Category: Critical Care Nursing Pulse oximetry targets the signal arising from the arterial bed as light absorbance fluctuates with changing blood volume. Arterial blood flow cause...
Category: Critical Care Nursing Peripheral hypoperfusion from hypothermia, low cardiac output or vasoconstrictive drugs can substantially lower SpO2 accuracy, reduce precision, and...
Category: Critical Care Nursing Mottling or prolonged capillary refill time (CRT) is suggestive of low cardiac output with great specificity but low sensitivity. A strategy guided...
Category: Critical Care Nursing Motion artifact and poor perfusion are the most common sources of SpO2 inaccuracies, which occur because the photoplethysmographic pulse signal is v...
Category: Critical Care Nursing Hypoxia is unlikely to occur in mild hypoxemia (PaO2 = 60-79 mm Hg) when cardiovascular reflexes remain intact. Moderate hypoxemia (PaO2 = 45-59 mm...
Category: Critical Care Nursing Both dark skin pigmentation and dark nail polish interfere with absorption of the wavelengths used by pulse oximetry. Pulse oximeters thus have grea...
Category: Critical Care Nursing The PaO2 is dependent on the fraction of inspired oxygen (FiO2), ventilation and perfusion matching (V/Q) and the mixed venous oxygen saturation (S...
Category: Critical Care Nursing Dark nail polish colors can falsely lower SpO2 values, whereas red polish tends not to affect pulse oximetry accuracy. However, with newer technolog...
Category: Critical Care Nursing Positive end-expiratory pressure (PEEP) may recruit collapsed alveoli, improve ventilation-perfusion matching, and reduce alveolar dead space, but...
Category: Critical Care Nursing In the 1990s, the pulmonary artery catheter was at its apogee, as it was the only method to assess/monitor hemodynamics. It measures cardiac output,...
Category: Critical Care Nursing The accuracy of pulse oximeters has improved over the years. In critically ill patients with an arterial oxygen saturation (SaO2) >90%, it is now...
Category: Critical Care Nursing Inotropic or vasoactive drugs may affect the PaCO2-PETCO2 gradient, either by increasing cardiac output and pulmonary perfusion or by reducing pul...
Category: Critical Care Nursing Often considered the “fifth vital sign,” pulse oximetry is one of the most important technologic advances for monitoring patients during anesthe...
Category: Critical Care Nursing Normal subjects have a PaCO2-PETCO2 gradient of 4-5 mm Hg. In critically ill patients, the PaCO2-PETCO2 gradient can be elevated, such as in obstru...
Category: Critical Care Nursing Falsely low SpO2 readings occur when minor gaps exist between the probe and skin, allowing light reflected off the skin to “shunt” directly to t...
Category: Critical Care Nursing Abnormalities in compliance and resistance in patients are dependent on both the cause and severity of the disease. Decreased compliance may occur...
Category: Critical Care Nursing At end expiration, if there is insufficient time for a patient to exhale completely to resting volume, gas gets trapped in the lungs, creating alve...
Category: Critical Care Nursing The oxyhemoglobin dissociation curve must be taken into account when interpreting the SpO2. If the curve is in a normal position, then high SpO2 val...
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