Abstract
BackgroundHemodynamic monitoring is very important in critically ill patients with shock or acute respiratory distress syndrome(ARDS). The PiCCO (Pulse index Contour Continuous Cardiac Output, Pulsion Medical Systems, Germany) system has been developed and used in critical care settings for several years. However, its impact on clinical outcomes remains unknown.Methods/designThe study is a randomized controlled multi-center trial. A total of 708 patients with ARDS, septic shock or both will be included from January 2012 to January 2014. Subjects will be randomized to receive PiCCO monitoring or not. Our primary end point is 30-day mortality, and secondary outcome measures include ICU length of stay, days on mechanical ventilation, days of vasoactive agent support, ICU-free survival days during a 30-day period, mechanical-ventilation-free survival days during a 30-day period, and maximum SOFA score during the first 7 days.DiscussionWe investigate whether the use of PiCCO monitoring will improve patient outcomes in critically ill patients with ARDS or septic shock. This will provide additional data on hemodynamic monitoring and help clinicians to make decisions on the use of PiCCO.Trial registrationhttp://www.clinicaltrials.gov NCT01526382
Highlights
Hemodynamic monitoring is very important in critically ill patients with shock or acute respiratory distress syndrome(ARDS)
We investigate whether the use of Pulse index Continuous Cardiac Output (PiCCO) monitoring will improve patient outcomes in critically ill patients with ARDS or septic shock
Pulmonary artery catheters (PACs) have been widely used for several decades only because they allow clinicians to get more information regarding hemodynamic status, but without clinical evidence of improved outcomes. In response to this lack of evidence, several randomized controlled trials have been conducted to test the usefulness of pulmonary artery catheter (PAC) in improving clinical outcomes [31,32,33]
Summary
Fluid therapy is an art in the treatment of critically ill patients. To facilitate treatment and improve patient outcomes, every effort has been made to enhance the technology used for measuring relevant physiological parameters. Pulmonary artery catheters (PACs) have been widely used for several decades only because they allow clinicians to get more information regarding hemodynamic status, but without clinical evidence of improved outcomes. The failure of PACs in improving clinical outcomes does not mean that the measurement of hemodynamic parameters is useless On the contrary, it reflects the limited understanding of the complex hemodynamic characteristics in critically ill patients. The current study aims to investigate the usefulness of the PiCCO system in improving outcomes for patient with ARDS and septic shock We believe that this randomized controlled trial will provide new evidence for fluid management in critical care settings.
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