ICU telemetry: beyond basic rhythm — continuous ST and parameter trending
ICU cardiac monitoring extends beyond rhythm identification. Key capabilities in ICU monitoring:
Continuous ST monitoring: most modern ICU monitors provide real-time ST-segment trending in multiple leads simultaneously. This detects silent ischemia in sedated, intubated, or post-operative patients who cannot report chest symptoms. Set ST alert thresholds (typically ±1–2mm from baseline) and review trends at minimum every 4 hours. New ST changes require immediate 12-lead ECG and provider notification.
Multi-parameter trending: ICU monitors integrate heart rate, rhythm, SpO₂, NIBP or arterial line BP, ETCO₂, and in some configurations pulmonary artery pressures. Correlate rhythm changes with hemodynamic parameters — a new tachyarrhythmia accompanied by BP drop has different urgency than the same rhythm with stable hemodynamics.
Post-cardiac arrest monitoring: patients achieving ROSC require continuous monitoring for recurrent arrhythmia, ST changes (identify STEMI requiring emergent PCI), QTc trending (targeted temperature management prolongs QTc — antiarrhythmics may need dose adjustment), and rhythm during rewarming (risk of arrhythmias at temperature transitions).