Table 1 Definition of intermediate care
Observation | Minimal monitoring levela | Treatments goalsb | Comments |
|---|---|---|---|
Level of consciousness | Every 8 h | GCS: 15 | |
Respiratory rate | Every second hour | RR: 10 to 20 | If the patient has stable vital signs the RR is not measured during nights |
Oxygenation | Continuous pulse oximetry | SpO2 ≥94% | Continuous pulse oximetry when the patient is supine or sitting in a chair. Discontinued during mobilisation |
Blood pressure | Every second hour | MAP: 65 to 110 mmHg | If the patient has stable vital signs the MAP is not measured during nights |
Heart rate | Continuous ECG monitoring | HR: 50 to 100 | Continuous ECG when the patient is supine or sitting in chair. Discontinued during mobilisation. Diagnostic ECG on indication. If arrhythmia or ischaemia is detected the treatment goals are adjusted to current recommendations |
No ischemia | |||
Diuresis | Every hour | ≥0.5 mL/kg/h | During mobilisation the diuresis is summed every third hour |
Temperature | Every 8 h | 36°C to 38°C | |
Pain Visual Assessment Score | Every 8 h | VAS: 0 to 2 during rest | No VAS scoring during sleep |
Epidural: Able to move both legs | |||
Central venous pressure | Every 8 h | 8 to 12 mmHg | CVP and S cVO2 is only registered if there is a central venous catheter in place. The central venous catheter is removed when possible |
Central venous oxygen saturation | Every 8 h | SpO2 ≥ 70% | |
Standard blood samples | Every 24 h | Within normal reference values | Hgb ≥4.5 mmol/L |
Hgb ≥6.0 during sepsis or heart disease | |||
Treatment (if needed) | Maximal treatment level | Treatments goals | Comments |
Single sympathomimetic drug support | Continuously | MAP: ≥65 mmHg | |
Diuresis: ≥0.5 mL/kg/h | |||
Oxygen therapy on open systems | Continuously | SpO2 ≥94% | Unless contraindicated, oxygen therapy is discontinued when oxygenation is ≥94% without oxygen therapy. During nights: minimum 2 L supplemental oxygen is given |
Positive Expiratory Pressure (PEP) therapy | Assistance to PEP therapy: once per hour | SpO2 ≥94% | If the patient does not need assistance with PEP therapy, guidance in self-administration of PEP therapy must be available |
Non-invasive ventilation | Continuously | Normocapnia and normoxic | |
Volume / Fluid therapy | Continuously | MAP: ≥65 mmHg | Fluid balance: Evaluation frequency in accordance with monitoring level and vital signs |
Diuresis: ≥0.5 mL/kg/h | |||
S cVO2 ≥70% | |||
CVP: 8 to 12 mmHg |