Vitals

Monitoring blood pressure, heart rate, fluid input/output, mental status, and the heart’s internal pressures and efficacy. The more invasive and extensive the measures taken for monitoring; the more tenuous the patient’s status.

    • Normal SpO2 in a healthy person is 97-99%. SpO2 value of 95% is clinically acceptable in a patient with normal hemoglobin levels.

    • A SpO2 value of 90% is generally equal to a Partial Pressure of Oxygen (PaO2) of 60 mmHg

    • Non-invasive, continuous monitoring of the electrical activity of the heart

    • Usually accurate however, position change and patient movement can alter the reading, creating false waves called artifact

    • Abnormal heart rate can indicate that other vital signs may be going askew.

    • Check radial pulse for confirmation if question regarding telemetry accuracy arises

    • Discuss with RN before entering the room to be aware of any problems with cardiac rhythm

    • Normal Range: 60-100bpm.

    • Bradycardia: <60

    • Tachycardia: >100

    • Normal Range: 60-80 mmHg

    • <50 or > 70 mmHg: Defer Therapy

    See CPP Section for more information

    • Normal Range: 5-15 mmHg

    • >20 mmHg: Defer therapy

    See ICP section for more information

    • Indicator of the heart’s ability to perfuse the body’s tissues. Considered better for central arterial pressure monitoring then just systolic pressure as a guide.

    • Normal Range: 70-110 mmHg

    • MAP of <70 mmHg is associated with poor outcomes in TBI

    • Normal Range: Systolic 90-120 mmHg, Diastolic 60-80 mmHg

    • Check BP before and after treatment and if the patient becomes symptomatic.

    • Normal for patients who have been on bed rest to experience brief periods (10-30 seconds) of light-headedness with position change.

    Orthostatics: take BP in supine, sitting, and standing. Considered orthostatic when systolic BP drops 20 mmHg or diastolic drops 10 mmHg within 3 minutes of orthostatic stress.

    *Be aware certain neuro patients will have specific BP parameters Which are in place to ensure adequate cerebral perfusion and prevent secondary brain injury.

    • BP > 180/110-120

    • Concern: organ damage (elevates from urgency to emergency)

    *Important to know your patients BP goals*

    • MAP <60-65 mmHg

    • Sustained hypotension: > 15 minutes; “episodes” tend to happen within 30 minutes

    Constantly reassessing. A balancing act!

Guidelines in which to defer therapy or consult the team

FIO2: ≥0.60 (60%) 

PEEP: ≥10 cm H2O 

Partial pressure of Oxygen (PaO2): 80-95 mmHg 

Oxygen Saturation (SaO2): Inability to maintain >90% 

Pulse oximeter (SpO2): <88% (case dependent) 

Heart rate: >130 or <30-40 bpm 

Blood Pressure: Baseline change >20 systolic or  >10 diastolic or  systolic BP >200 mm Hg or  <90 mm Hg 

Respiratory Rate: >40 breaths/min 

Mean Arterial Pressure (MAP): >110 mm Hg or <65 mm Hg 

Cerebral Perfusion Pressure (CPP): < 50 or >70 mmHg

Intracranial Pressure (ICP): >20 

References

Brummel, N. E., Jackson, J. C., Girard, T. D., Pandharipande, P. p., Schiro, E., Work, B., Pun, B. T., Boehm, L., Gill, T. M., & Ely, E. W. (2012). A combined early cognitive and physical rehabilitation program for people who are critically ill: The activity and cognitive therapy in the intensive care unit (ACT-ICU) trial. Physical Therapy, 92(12), 1580–1592. https://doi.org/10.2522/ptj.20110414

Engel, H. J., Needham, D. M., Morris, P. E., & Gropper, M. A. (2013). ICU early mobilization: From recommendation to implementation at three medical centers. Critical Care Medicine, 41, S69–S80. https://doi.org/10.1097/CCM.0b013e3182a240d5

Hodgson, C. L., Stiller, K., Needham, D. M., Tipping, C. J., Harrold, M., Baldwin, C. E., Bradley, S., Berney, S., Caruana, L. R., Elliott, D., Green, M., Haines, K., Higgins, A. M., Kaukonen, K.-M., Leditschke, I. A., Nickels, M. R., Paratz, J., Patman, S., Skinner, E. H., … Webb, S. A. (2014). Expert consensus and recommendations on safety criteria for active mobilization of mechanically ventilated critically ill adults. Critical Care, 18(6), 658. https://doi.org/10.1186/s13054-014-0658-y

Holm, S. (2017). Early Mobility and Rehabilitation. In H. Smith-Gabai & S. E. Holm (Eds.), Occupational Therapy in Acute Care (2nd ed., pp. 663–672). AOTA Press. https://library.aota.org/OT_in_Acute_Care_2e/134?highlightText=intensive%20care%20unit

Linke, C. A., Chapman, L. B., Berger, L. J., Kelly, T. L., Korpela, C. A., & Petty, M. G. (2020). Early mobilization in the ICU: A collaborative, integrated approach. Critical Care Explorations, 2(4), e0090. https://doi.org/10.1097/CCE.0000000000000090

Mendez-Tellez, P. A., & Needham, D. M. (2012). Early physical rehabilitation in the ICU and ventilator liberation. Respiratory Care, 57(10), 1663–1669. https://doi.org/10.4187/respcare.01931

Peixoto, A. J. (2019). Acute severe hypertension. New England Journal of Medicine, 381(19), 1843–1852. https://doi.org/10.1056/NEJMcp1901117

Popovich, K. (2011). The Intensive Care Unit. In H. Smith-Gabai (Ed.), Occupational Therapy in Acute Care (1st ed., pp. 41–73). AOTA Press.

Yapps, B., Shin, S., Bighamian, R., Thorsen, J., Arsenault, C., Quraishi, S. A., Hahn, J.-O., & Reisner, A. T. (2017). Hypotension in ICU patients receiving vasopressor therapy. Scientific Reports, 7(1), 8551. https://doi.org/10.1038/s41598-017-08137-0