[Vital signs of hemodynamic monitoring]. / I parametri vitali del monitoraggio emodinamico.

The aim of hemodynamic monitoring in intensive care is to recognize derangements in physiologic variables, which herald the progression toward organ failure. Traditionally the term "vital signs" refers to heart rate, arterial pressure, respiratory rate and body temperature monitoring. Continuous monitoring of vital signs, is advocated, since trends are more significant than single measurements, and is still a cornerstone, in the hemodynamic evaluation of a critically ill patient. Nevertheless, the spectrum of hemodynamic derangements that can arise during intensive care unit stay is very large and often additional information, beside the vital signs, are needed to evaluate correctly the individual patient.

[Ventilator associated pneumonia]. / La polmonite da ventilatore.

Ventilator associated pneumonia (VAP) is a nosocomial lower respiratory tract infection that ensues in critically ill patients undergoing mechanical ventilation. The reported incidence of VAP varies between 9% and 68% with a mortality ranging between 33% and 71%. Two key factors are implicated in the pathogenesis of VAP: bacterial colonization of the upper digestive-respiratory tract and aspiration of oral secretions into the trachea. Preventive measurements are advocated to reduce the incidence of VAP, such as selective decontamination of the digestive tract (SDD), supraglottic aspiration and positioning. Prompt recognition and treatment of established VAP has also been demostrated to affect outcome. Therefore, the knowledge of risk factors associated with the development of VAP and the implementation of strategies to prevent, diagnose and treat VAP are mainstems in the nursing of mechanically ventilated patients.

[Nursing of intubation]. / Nursing dell'intubazione.

Recent developments in noninvasive ventilation allow the intensivists to delay the time o intubation of the patient admitted to the ICU. This new possibility of a gain in time leads to the fact that those patients who are intubated in the ICLI, are patients with a very compromised hemodynamic and respiratory situation. For this reason, we developed a specific protocol regarding the intubation procedure of this kind of patients. This paper reviews our strategies for endotracheal tube positioning in critically ill patients and shows the fundamental role of the nurses during this procedure.

Monitoring of intra-abdominal pressure.

Intra-abdominal pressure monitoring is a very important parameter in the ICU setting, since pathological alterations of this value are significant and are responsible for functional alterations involving cardio-respiratory system, kidneys and central nervous system. Responsibility of the professional nurse in the ICU is to perform a tight and adequate monitoring of those patients who are at risk for a rise in intra-abdominal pressure.

Oxygen saturation monitoring.

Pulse-oximeter is described as the most important technological proceeding for monitoring the patients' safety during anesthesia, after surgery and in emergency. This opinion was widely confirmed in the 1990s when pulse-oximeter has been definitively introduced in the standard for base monitoring in the OR and has been proposed for routinary use also in the ICU. In this paper we consider the importance, in the cardiovascular, respiratory and brain parameters monitoring, of continuous oximetry of mixed venous blood (SVO2) and blood venous saturation in the internal jugular vein (SjvO2).

[Vascular catheter positioning and maintenance]. / Posizionamento e mantenimento del catetere vascolare.

The paper highlights the importance of invasive pressure monitoring systems. The most common catheters are considered (intra-arterial, Swan/Ganz, central venous), catheter positioning (appropriate sites, risks and early and late complications of intravascular cannulation), evaluation of pressure and finally the role of nursing in the management of the intravascular catheter in situ (care of cannulation site, management of the catheter).