Non-Cardiopulmonary Monitoring in Thai-ICU (ICU-RESOURCE I Study)
Kaweesak Chittawatanarat MD, PhD*1, Sunthiti Morakul MD*2, Thammasak Thawitsri MD*3, Thai Society of Critical Care Medicine Study group*4
Affiliation : *1 Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand *2 Department of Anesthesiology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand *3 Department of Anesthesiology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand *4 The Thai Society of Critical Care Medicine, Royal Jubilee Building, Bangkok, Thailand
Objective : In addition to cardiopulmonary monitoring, non-cardiopulmonary monitoring (non-CPM) is considered to be an
important parameter in intensive care units (ICUs). However, no data on this subject has been reported for Thai ICUs. The
objective of the present study is to describe the non-CPM situation in Thai ICUs.
Materials and Method: ICU RESOURCE I survey database released during the year 2012 was used for the present study.
Non-CPMo refers to neurological monitoring, renal function monitoring, metabolic monitoring, perfusion monitoring and
identifying biomarkers. Academic hospital (ACAD), availability grading (AG), numeric frequency grading scale (FGS) and
device availability per bed (DPB) were used for categorization of non-CPM collected data. Significant differences between the
groups are defined as p<0.05.
Results : Advanced monitoring, including; indirect calorimetry, near infrared spectroscopy, peripheral nerve stimulation, gut
mucosal tonometry and sublingual side stream dark field imaging are currently unavailable in participating Thai ICUs. All
ICUs have devices to measure the levels of capillary glucose, creatinine kinase MB, troponin T and albumin. Bispectral index,
ultrasound, continuous renal replacement therapy devices, continuous enteral feeding pumps, intra-abdominal pressure
monitoring devices and rectal temperature measuring devices are available in ACAD facilities in greater instances than in
other institutions. Similarly; for biomarker and drug level monitoring; procalcitonin, interleukin, brain natriuretic peptide,
total creatinine kinase, neutrophilgelatinase-associated lipocalin (NGAL), lactate, central venous oxygen saturation/mixed
venous oxygen saturation (ScvO2/SvO2), phenytoin, vancomycin and pre-albumin are used more frequently in ACADs. Gap
analysis demonstrating warmer cabins, NGAL, lactate and ScvO2/SvO2 show less availability but are frequently used when
they have been made available. Intra-abdominal pressure and core temperatures are used less in general ICU practices and
are scarcely found.
Conclusion : Some of the more advanced non-CPM devices are not found in Thai ICUs. Basic non-CPM devices are
available in all ICUs. Some new devices for measurements and for biomarkers are used with greater prevalence in ACAD
ICUs. Some measurements including IAP, core temperature, lactate and ScvO2/SvO2) are monitored less frequently in Thai
ICUs (Thai Clinical Trial Registry: TCTR-201200005).
Keywords : Non-cardiopulmonary monitoring, Thai, Intensive care unit, Utilization gap, Frequency level, Device availability
