What monitoring should be performed on a patient with shock?

In general, monitoring of patients with shock should focus on circulation, organ function, and changes in clinical condition. The core monitoring items mainly include vital signs, circulatory function, renal function, blood gas analysis, and level of consciousness. A detailed analysis is as follows:

1. Vital Signs Monitoring: Continuous monitoring of body temperature and heart rate is required. Abnormal temperature may indicate infection or circulatory impairment; tachycardia is often an early compensatory response in shock, while excessively rapid or sudden drop in heart rate suggests deterioration of the condition.

2. Circulatory Function Monitoring: Includes central venous pressure (CVP) and urine output. CVP reflects blood volume and right ventricular function, with a normal range of 5–12 cmH₂O. A value below this range indicates hypovolemia, while a higher value may suggest cardiac dysfunction. Urine output is a key indicator of renal perfusion and should be recorded hourly; output less than 30 mL/h indicates inadequate perfusion.

3. Renal Function Monitoring: In addition to urine output, serum creatinine and blood urea nitrogen (BUN) should be regularly tested. Insufficient renal perfusion during shock can easily lead to acute kidney injury. Elevated creatinine and BUN levels indicate impaired renal function and require adjustments in fluid resuscitation and diuretic use to prevent further deterioration.

4. Blood Gas Analysis Monitoring: Arterial blood gas analysis provides information on acid-base balance, oxygenation status, and lactate levels. Abnormal pH indicates acid-base imbalance requiring prompt correction. Decreased oxygen saturation and arterial partial pressure of oxygen (PaO₂) suggest tissue hypoxia, necessitating adjustment of oxygen concentration or respiratory support strategies.

5. Level of Consciousness Monitoring: Close observation of whether the patient is alert, drowsy, or comatose is essential. Changes in consciousness are related to cerebral perfusion and hypoxia. Early signs may include restlessness; as cerebral hypoxia worsens, the patient may become apathetic, then progress to somnolence, and eventually fall into coma. Deterioration in consciousness indicates disease progression.

Monitoring of patients with shock must be real-time and dynamic. Healthcare providers should promptly adjust infusion rates, doses of vasoactive drugs, and organ support strategies based on monitoring results. Additionally, trends in monitored data should be documented to aid in correcting shock and improving prognosis.