Experiencia clínica de monitorización hemodinámica del shock mediante el sistema PiCCO ®

Abstract

Purpose To evaluate the PiCCO ® hemodynamics monitor in terms of clinical usefulness in children with shock. Methods Prospective multicenter analytical study in children aged from one month to 18 years with shock admitted to five pediatric intensive care units. Measurements were made before and after three interventions: a) volume load; b) increases in vasoactive drugs; c) dosage changes of drugs that could lessen vascular resistance. Recorded parameters included thermodilution data, along with the usual hemodynamic parameters. Results A total of 120 measurements were performed on 35 patients: mean age 36 (2.6–156) months, mean weight 15 (5.8–72) kg. Shock etiology was septic in 37% of cases, cardiogenic in 26%, hypovolemic in 20% and neurogenic in 17%. No procedure related complication was noticed. Twenty-two volume challenges in 17 patients were registered. Volume load induced a significant intrathoracic blood volume index (ITBI) increase from 501(235–763) to 584 (418–810) ml/m 2, cardiac index (CI) 4.04 (2.58–6.25) to 4.48 (2.86–8.71) l min-1 m 2, and mean blood pressure from 74 (53–99) to 87 (59–112) mmHg. CI changes correlated with ITBI increase (r=0.678, p=0.001). 13 interventions to increase vasomotor tone were associated with an increase in contractility of 18% in systemic vascular resistance index (SVRI). Conclusions Hemodynamic monitoring with the PiCCO ® system is feasible and seems safe in children with shock. PiCCO ® derived parameters could add clinically important information to assess preload state and its modifications with therapy.