PiCCO Monitoring Research Articles

THE USE PICCO TECHNOLOGY FOR ASSESSMENT THE FUNCTIONAL STATE OF THE HEART AND SYSTEMIC GEODYNAMICS DURING ORTHOTOPIC HEART TRANSPLANTATION

Summary. Approximately 5000 heart transplants are performed annually in the world. According to the American College of Cardiology/American Heart Association/ Heart Failure Society of America (ACC/AHA/HFSA) and the European Society of Cardiology (ESC), there are currently more people on the waiting list for heart transplants than there are donor organs available. The Ukrainian National Waiting List of the Unified State Transplantation Information System contains more than 2,000 patients, of whom about 500 need a heart transplant. Objective. The aim was to evaluate the effectiveness of haemodynamic monitoring using a continuous analysis system for measuring pulse waveform and transpulmonary thermodilution and its impact on orthotopic heart transplantation. Materials and methods. The work is based on the results of 30 recipients diagnosed with dilated cardiomyopathy who underwent orthotopic heart transplantation. The average age of the recipients was 41.4±3.2 years. There were 90 % of male recipients and 10 % of female recipients. All recipients were diagnosed with dilated cardiomyopathy with reduced ejection fraction with an average of 18 ± 4.4 %. All patients underwent heart transplantation using PiCCO hemodynamic monitoring, which assessed the optimality of fluid, inotropic and vasopressor therapy with analysis of changes in the functional state of systemic hemodynamic (blood pressure, heart rate, central venous pressure, cardiac index, cardiac output, global end-diastolic volume index, extravascular lung water index, systemic vascular resistance and global ejection fraction) at the time of donor heart inclusion in the recipient’s circulation Results. It was found that all patients had a reduced ejection fraction. In 100% of patients undergoing orthotopic heart transplantation, PiCCO monitoring was used, which showed cardiac dysfunction with a reduced cardiac index of 1.90 ± 0.24 l/min/m on average, global end-diastolic blood volume index was 571 ± 163.7 ml/m2 and was reduced, reflecting a decrease in preload. While the extravascular water index in the lungs averaged 9.2 ± 1.41 ml/kg of body weight and was increased, indicating possible pulmonary oedema at the beginning of surgery. Conclusions. PiCCO monitoring allows real-time diagnosis of functional changes in the myocardium, differentiation of major circulatory disorders in patients with involvement of vital organs and systems, including breathing (gas exchange), classification of haemodynamic disorders and timely correction. During the study, PiCCO monitoring revealed an improvement in extravascular lung water in 95 % of patients by the end of CPR, which made it possible to adequately treat these disorders and prevent pulmonary oedema, provide adequate correction with inotropic support and balance postload with the systemic vascular resistance index and improve the cardiac index by 99.1 %.

Summary of best evidence for pulse contour cardiac output monitoring in severe burn patients

Objective: To summarize the best evidence for pulse contour cardiac output (PiCCO) monitoring in severe burn patients. Methods: A bibliometric approach was used. Foreign language databases including UpToDate, BMJ Best Practice, Joanna Briggs Institute Evidence-Based Practice Database, Cochrane Library, PubMed, Web of Science, Embase, Medline, and Guideline International Network, as well as Chinese databases such as China National Knowledge Infrastructure, Wanfang Database, and VIP Database were systematically retrieved to obtain all the publicly published evidence on PiCCO monitoring in severe burn patients in each database from the establishment of each database to May 2022, including guidelines, expert consensus, evidence summary, systematic review, and original research. The literature was screened and evaluated for the quality, from which the evidences were extracted, evaluated, and classified to summarize the best evidences. Results: Three guidelines, two expert consensuses, one evidence summary (with two systematic reviews being traced), two systematic reviews, three randomized controlled trials, one cohort study, and one case-control study were retrieved and included, with good quality of literature. Totally 37 pieces of best evidences about PiCCO monitoring in severe burn patients were summarized from the aspects of pre-operation evaluation, pipe placement and operation, monitoring system establishment, pipeline maintenance, and supervision and education. Conclusions: Totally 37 pieces of best evidences about PiCCO monitoring in severe burn patients are summarized from 5 aspects, providing a basis for the clinical implementation of scientific and standardized PiCCO monitoring and nursing management.

Meta-analysis of PiCCO monitoring and guiding the use of vasoactive drugs in the treatment of septic shock patients

As a clinical monitoring method, PiCCO has been widely used in the monitoring of patients with septic shock in recent years. However, it has not been concluded whether PiCCO has more clinical advantages than traditional central venous pressure monitoring. In this paper, 868 literatures were collected through meta-analysis, and 3 literatures meeting the inclusion criteria were screened according to the exclusion criteria set in advance, and a total of 5 studies were obtained.Statistical analysis is conducted by Revman5.4 software provided by Cochrane, and the conclusion is as follows: PICCO monitoring technology can significantly reduce the use of vascular active drugs for patients with purulent septic shock, among which norepinephinxin Z=9.09（P <0.00001), dopamine Z = 4.92 (P <0.00001). Therefore, we recommend using Picco technology clinically.

МОНИТОРИНГ ЦЕНТРАЛЬНОЙ ГЕМОДИНАМИКИ У ПАЦИЕНТОВ С СИНДРОМОМ ПОЛИОРГАННОЙ НЕДОСТАТОЧНОСТИ

Objective: comparative analysis of the use of PiCCO monitoring for correction of the intensive care in patients with multiple organ dysfunction syndrome (MODS) after abdominal and cardiac surgery. Material and methods. A prospective cohort study was carried out in 19 patients with MODS after abdominal (n=10) and cardiac (n=9) interventions. Of these, 13 men and 6 women, aged 63 (58-69) years, their height was 176 (174-180) cm, body weight - 90 (80-100) kg. Central hemodynamic parameters were monitored in these patients by the PiCCO method. Several steps have been distinguished in the study: 1st stage - 1st day after surgery, 2nd stage - 2nd day after surgery, etc. Results. In patients after cardiac surgery, compared with the group of patients after abdominal surgery, significantly (p <0.001) lower preload indices (global end-diastolic volume and index, intrathoracic blood volume and index) were noted at 1-2 stages, as well as significantly (p<0.05) lower rates of contractility (continuous cardiac output and index at 1-4 stages, stroke volume and index at 1-5 stages). When analyzing the treatment in patients after cardiac surgery, the frequency of dobutamine use (p=0.017) and the frequency of simultaneous use of 3 vasoactive substances (p=0.0495) were statistically significantly higher than in patients undergoing abdominal surgery. Conclusions. Monitoring of central hemodynamics enables to individualize infusion therapy, vasopressor and inotropic support in patients with MODS after abdominal and cardiac surgery.

Afterload-related cardiac performance identifies cardiac impairment and associates with outcome in patients with septic shock: a retrospective cohort study

BackgroundSeptic patients with cardiac impairment are with high mortality. Afterload-related cardiac performance (ACP), as a new tool for diagnosing septic cardiomyopathy (SCM), still needs to be evaluated for its impact on the prognosis for patients with septic shock.MethodsIn this retrospective study, 100 patients with septic shock undertaken PiCCO monitoring were included. The ability of ACP, cardiac index (CI), and cardiac power index (CPI) to discriminate between survivors and non-survivors was tested by comparing the area under the receiver operating characteristic curve (AUROC) analysis. Cox proportional hazards regression analyses were performed to assess the associations of ACP with day-28 mortality. Curve estimation was used to describe the relationship between the hazard ratio (HR) of death and ACP.ResultsACP had a strong linear correlation with CI and CPI (P < 0.001). ACP demonstrated significantly greater discrimination for day-28 mortality than CI before adjusted [AUROC 0.723 (95% CI 0.625 to 0.822) vs. 0.580 (95% CI 0.468 to 0.692), P = 0.007] and CPI after adjusted [AUROC 0.693 (95% CI 0.590 to 0.797) vs. 0.448 (0.332 to 0.565), P < 0.001]. Compared with ACP > 68.78%, HR for ACP ≤ 68.78% was 3.55 (1.93 to 6.54) (P < 0.001). When adjusted with age, APACHE-II score, Vasoactive Inotropic Score, Lactate, CRRT, day-1 volume, fibrinogen and total bilirubin as possible confounders, and decrease ACP are still associated with increasing day-28 mortality (P < 0.05). An exponential relationship was observed between ACP12h and HR of day-28 death.ConclusionsOur results suggested thatACP could improve mortality predictions when compared to CI and CPI. Decreased ACP was still an independent risk factor for increased day-28 mortality.

Application of pulse contour cardiac output monitoring technology in fluid resuscitation of severe burn patients in shock period

Objective: To investigate the application of pulse contour cardiac output (PiCCO) monitoring technology in fluid resuscitation of severe burn patients in shock period. Methods: From January 2015 to December 2019, 33 patients with severe burns who were hospitalized in Guangzhou Red Cross Hospital, meeting the inclusion criteria, were recruited into a retrospective cohort study with their clinical information collected. The patients were divided into PiCCO monitoring group with 15 cases (13 males and 2 females, aged (43±13) years) and routine monitoring group with 18 cases (14 males and 4 females, aged (39±9) years) according to the monitoring method used. After admission, all the patients were rehydrated following the rehydration formula of the Third Military Medical University for shock period. In routine monitoring group, the fluid resuscitation of patients was performed by monitoring indicators such as urine volume and blood pressure, while PiCCO monitoring was performed among patients in PiCCO monitoring group, and their fluid resuscitation was guided by the patient's condition and the hemodynamic parameters (without pursuing normal levels of the parameters) of PiCCO monitoring on the basis of normal monitoring indicators in routine monitoring group. The colloids coefficients, the electrolyte coefficients (compared with the corresponding rehydration formula value of 0.75 mL·kg(-1)·% total body surface area (TBSA)(-1) of the Third Military Medical University for shock period during the first 24 h post injury), the total rehydration coefficients, and the urine volumes during the first and second 24 h post injury, the lactic acid level, the base excess level, and the oxygenation index at admission and 24, 48 h after admission, and the mechanical ventilation time, the wound healing time, and the death ratio of patients in the two groups were recorded. The cardiac index, the global end-diastolic volume index (GEDVI), the intrathoracic blood volume index (ITBVI), the extravascular lung water index (EVLWI), and the systemic vascular resistance index (SVRI) of patients in PiCCO monitoring group at post injury hour 24, 48, and 72 and the abnormal cases were recorded. Data were statistically analyzed with Fisher's exact probability test, independent-sample or one-sample t test, analysis of variance for repeated measurement, and Bonferroni correction. Results: During the first 24 h post injury, the colloids coefficients of patients in PiCCO monitoring group was (0.69±0.15) mL·kg(-1)·%TBSA(-1), which was significantly less than (0.85±0.16) mL·kg(-1)·%TBSA(-1) in routine monitoring group (t=-2.612, P<0.05). Compared with the rehydration formula value of the Third Military Medical University for shock period, only the colloids coefficient of patients in routine monitoring group during the first 24 h post injury was significantly increased (t=2.847, P<0.05). There were no statistically significant differences between the two groups in the colloids coefficients of patients during the second 24 h post injury, or the electrolyte coefficients, the total rehydration coefficients, the urine volumes of patients during the first and the second 24 h post injury (t=0.579, -0.011, 0.417, -1.321, -0.137, 0.031, 1.348, P>0.05). The lactic acid level, the base excess level, the oxygenation index of patients at admission and 48 h after admission, and the oxygenation index of patients at 24 h after admission between the two groups were similar (t=-1.837, 0.620, 0.292, -1.792, 1.912, -0.167, 1.695, P>0.05). The levels of lactic acid and base excess of patients in PiCCO monitoring group were (4.8±1.4) and (1.2±5.5)mmol/L, respectively, which were significantly better than (7.0±1.5) and (-2.8±3.0) mmol/L in routine monitoring group at 24 h after admission (t=-3.904, 2.562, P<0.05 or P<0.01). There were no statistically significant differences between the two groups in the mechanical ventilation time or the wound healing time of patients (t=-0.699, -0.697, P>0.05), or the death ratio of patients (P>0.05). In PiCCO monitoring group, the GEDVI, and the ITBVI of patients were lower than the normal low values at post injury hour 24 and 48, which were in the normal range at post injury hour 72; the cardiac index of patients increased gradually and recovered to normal at post injury hour 48; the SVRI of patients increased significantly at post injury hour 24 and then gradually decreased to normal; the EVLWI average of patients at all time points post injury were less than 10 mL/kg. At post injury hour 24, most of the hemodynamic parameters of more than or equal to 8/15 patients in PiCCO monitoring group were abnormal, and the abnormal proportion decreased later. Conclusions: On the basis of traditional monitoring indicators, the use of PiCCO monitoring technology combined with the patient's condition (without pursuing normal levels of the parameters) in guiding the fluid resuscitation in severe burn patients can reduce the usage of colloid and better improve tissue perfusion, with the resuscitation effect being better than conventional monitoring.

Prognostic value of pulmonary oedema assessed by lung ultrasound in patient with acute heart failure

It is very important to assess pulmonary oedema in patients with acute heart failure. The aim of the study was to investigate the accuracy of lung ultrasound in evaluating pulmonary oedema and to explore lung ultrasound in predicting the prognosis. One hundred twenty-four acute heart failure patients were divided into 3 groups, according to the total number of lung ultrasound B-lines groups: B-lines < 15 was the mild pulmonary oedema group (33 cases), 15 ≤ B-lines < 30 was the moderate pulmonary oedema group (33 cases), and B-lines ≥ 30 was the severe pulmonary oedema group (58 cases). The PiCCO monitoring system was used in 11 patients and measured 26 times in different clinical situations. EVLWI have a higher positive correlation with B-lines (r = 0.95), compared with NT-proBNP and E/e' (r = 0.72, r = 0.62). During 1 year of follow-up, a multivariate cox regression analysis showed that age, E/e' and B-lines ≥ 30 at admission (C-index of 75%) were risk factors for prognosis. 12-month event-free survival showed a significantly worse outcome was observed in patients with ≥ 30 B-lines at admission. B-lines have a good correlation with EVLWI; age, E/e' and B-lines ≥ 30 at admission were risk factors for prognosis.

Effect of fluid resuscitation guided by pulse contour cardiac output monitoring technology on organ function in extremely severe burn patients

Effect of fluid resuscitation guided by pulse contour cardiac output monitoring technology on organ function in extremely severe burn patients

Effects of pulse contour cardiac output monitoring technology in amelioration of myocardial damage in fluid resuscitation of patients with large area burn in the early stage

Objective: To analyze effects of pulse contour cardiac output (PiCCO) monitoring technology in amelioration of myocardial damage in fluid resuscitation of patients with large area burn in the early stage. Methods: From November 2015 to November 2017, medical data of 52 patients with large area burn hospitalized in our unit, meeting the inclusion criteria, were analyzed retrospectively. Twenty-seven patients (18 males and 9 females) with age of (43±10)years in tradition group hospitalized from November 2015 to November 2016 were monitored by traditional monitoring methods for fluid resuscitation, and 25 patients (18 males and 7 females) with age of (44±10)years in PiCCO group hospitalized from December 2016 to November 2017 were monitored by traditional monitoring methods and PiCCO monitoring equipment for fluid resuscitation. Fluid infusion coefficients and total fluid replacement volume of patients in both groups at the first and second post burn hour (PBH) 24, as well as the levels of N terminal pro B type natriuretic peptide (NT-proBNP), cardiac troponin T (cTnT), and creatine kinase MB (CK-MB) immediately on admission and post burn day (PBD) 1, 2, 3, 4, 5, 6, and 7 were recorded. Data were processed with analysis of variance for repeated measurement, chi-square test, t test and Bonferroni correction, and Mann-Whitney U test and Bonferroni correction. Results: (1) The fluid infusion coefficients of patients in tradition group at the first and second PBH 24 were respectively (1.42±0.10) and (0.94±0.14)mL·kg(-1)·% total body surface area (TBSA)(-1), and those in PiCCO group were respectively (1.76±0.14) and (0.85±0.08) mL·kg(-1)·%TBSA(-1). Fluid infusion coefficient and total fluid replacement volume at the first PBH 24 of patients in PiCCO group were significantly higher than those in tradition group (t=-9.775, -4.769, P<0.01). Fluid infusion coefficient at the second PBH 24 of patients in PiCCO group was significantly lower than that in tradition group (t=2.682, P<0.05). There was no statistically significant difference in total fluid replacement volume at the second PBH 24 in patients between the two groups (t=1.167, P>0.05). (2) Immediately on admission and PBD 1, 2, 3, 4, 5, 6, and 7, the levels of NT-proBNP of patients in tradition group were respectively 518 (320, 763), 236 (98, 250), 139 (62, 231), 172 (104, 185), 296 (225, 341), 727 (642, 921), 1 840 (1 357, 2 081), 1 005 (671, 1 297) pg/mL, and those in PiCCO group were respectively 444 (206, 601), 66 (29, 73), 54(28, 75), 139(101, 175), 199 (106, 279), 576 (333, 837), 833 (466, 1 080), 485 (225, 710) pg/mL. The levels of NT-proBNP of patients in PiCCO group on PBD 1, 2, 6, and 7 were significantly lower than those in tradition group (Z=-5.004, -3.967, -5.285, -4.626, P<0.01). The levels of NT-proBNP immediately on admission and PBD 3, 4, and 5 in patients between the two groups were close (Z=-0.834, -0.806, -2.665, -2.153, P>0.05). (3) Immediately on admission and PBD 1, 2, 3, 4, 5, 6, and 7, the levels of cTnT of patients in tradition group were respectively (42±15), (21±12), (17±7), (11±4), (12±4), (94±32), (88±23), (42±23) pg/L, and those in PiCCO group were respectively (37±15), (9±3), (10±3), (13±3), (12±5), (85±30), (60±26), (22±14) pg/L. The levels of cTnT of patients in PiCCO group on PBD 1, 2, 6, and 7 were significantly lower than those in tradition group (t=5.227, 4.751, 4.239, 3.845, P<0.01). The levels of cTnT immediately on admission and PBD 3, 4, and 5 of patients between the two groups were close (t=1.098, -1.562, -0.117, 1.107, P>0.05). (4) The levels of CK-MB of patients in PiCCO group on PBD 3, 6, and 7 were significantly lower than those in tradition group (t=3.123, 4.103, 3.178, P<0.05 or P<0.01). The levels of CK-MB immediately on admission and PBD 1, 2, 4, and 5 in patients between the two groups were close (t=0.351, 1.868, 1.100, 0.798, 2.094, P>0.05). Conclusions: PiCCO monitoring technology can monitor and guide fluid resuscitation of patients with large area burn in the early stage more scientifically and reasonably, and the effect of reducing myocardial damage is better than traditional monitoring methods.

Hemodynamic consequences of intravenously given E. coli suspension: observations in a fulminant sepsis model in pigs, a descriptive case\u2013control study

BackgroundThe aim of the present work was to assess systemic hemodynamic changes using PiCCo monitoring in a porcine model of E. coli-induced fulminant sepsis.MethodsThirty-one healthy female Hungahib pigs were randomly assigned into control (n = 15) or septic groups (n = 16). In the sepsis group Escherichia coli culture was intravenously administrated in a continuously increasing manner according to the following protocol: 2 ml of bacterial culture suspended in physiological saline was injected in the first 30 min, then 4 ml of bacterial culture was administered within 30 min, followed by infusion of 32 ml bacterial culture for 2 h. Control animals received identical amount of saline infusion. Systemic hemodynamic parameters were assessed by PiCCo monitoring in both groups.ResultsResting hemodynamic parameters were identical in the two groups. In control animals, systemic hemodynamic variables were relatively stable during the entire procedure. In septic animals shock developed in 165 (IQR: 60–255) min after starting the injection of E. coli solution. Blood pressure values gradually decreased, whereas pulse rate increased. A decrease in cardiac index, an increased systemic vascular resistance, and a decreased stroke volume variation were observed.ConclusionsThese results may serve as additional pathophysiological information of hemodynamic changes occurring during hypodynamic sepsis and may contribute to a better understanding of the pathomechanism of septic multiple organ failure.

Changing Characteristics of Extravascular Lung Water After Fluid Resuscitation in Septic Shock Patients by Early PiCCO Monitoring

This study aims to explore the changing characteristics of extravascular lung water after fluid resuscitation in septic shock patients by early PiCCO monitoring. 42 patients who were admitted to the ICU in our hospital and diagnosed as septic shock were collected. The patients were divided into two groups: treatment group (PiCCO group) (n=21) and control group (CVP group) (n=21). They were given early fluid resuscitation using different monitoring methods on the basis of conventional treatment for septic shock to monitor the changes of hemodynamics, EVLWI, oxygenation index (PaO2/FiO2) and BNP level before and after resuscitation. The BNP and LAC levels of the treatment group were significantly lower than those of the control group within 72 h (P 0.05). ITBVI and GEDVI immediately, 12 h and 24 h after the fluid resuscitation were increased in the two groups compared with those before, between which the difference was statistically significant (P 0.05). Early fluid resuscitation under the guidance of PiCCO has significant effect, which can be used as one of indicators for hemodynamic monitoring.

Sustained low efficiency dialysis should not be interrupted for performing transpulmonary thermodilution measurements

BackgroundTreatment of multiple organ failure frequently requires enhanced hemodynamic monitoring. When renal replacement is indicated, it remains unclear whether transpulmonary thermodilution (TPTD) measurements are influenced by renal replacement therapy (RRT) and whether RRT should be paused for TPTD measurements. Our aim was therefore to investigate the effect of pausing RRT on TPTD results in two dialysis catheter locations.Materials and methodsIn total, 62 TPTD measurements in 24 patients (APACHE: 32 ± 7 [mean ± standard deviation (SD)]) were performed using the PiCCO™ system (Pulsion, Germany). Patients were treated with sustained low efficiency dialysis (SLED; Genius™ system, Fresenius, Germany) as RRT. Measurements were taken during ongoing hemodialysis (HD, HDO), during paused HD (HDP) and immediately after termination of HD and blood restitution (HDT). Dialysis catheters were placed either in the superior vena cava (SVC, 19 times) or in the inferior vena cava (IVC, 5 times). Statistical analysis was performed to assess the effects of the measurement setting, SLED (blood flow rate) and the catheter location, on cardiac index (CI), global end-diastolic volume index (GEDVI) and extravascular lung water index (EVLWI) as measured by TPTD. Multilevel models were used for the analysis due to the triplicate measurements and due to 12 out of 19 SVC and 2 out of 5 IVC patients having more than one TPTD measured.ResultsCI and GEDVI were significantly higher at time point HDP compared to both HDO and HDT. In contrast, values for EVLWI were lower at HDP when compared to HDO and HDT. These findings were independent of the site of dialysis catheter insertion and blood flow rate.ConclusionsPiCCO™ measurements assessed at paused SLED significantly deviate from ongoing and terminated SLED. Therefore, the dialysis system should not be paused for measurements. TPTD measurements in patients with PiCCO monitoring seem sufficiently reliable during ongoing SLED as well as after its termination. An effect of dialysis catheter location (SVC vs IVC) and blood flow rate on PiCCO™ measurements could not be shown.

National experts consensus on application of pulse contour cardiac output monitoring technique in severe burn treatment (2018 version)

As a newly developed technique for hemodynamic monitoring, pulse contour cardiac output (PiCCO) monitoring takes great advantages in guiding shock resuscitation and fluid administration. PiCCO has been used more and more in burn patients in recent years, however there is no clinic consensus on how to apply PiCCO monitoring, understand the significance of PiCCO monitored parameters, and guide the treatment using PiCCO monitored parameters in patients with severe burns. Based on the current literature and the experts' clinical experience, national experts consensus on application of pulse contour cardiac output monitoring technique in severe burn treatment (2018 version) is now issued by the Burn and Trauma Branch of Chinese Geriatrics Society, aiming to provide practical guidance for its usage in clinic.

National experts consensus on application of pulse contour cardiac output monitoring technique in severe burn treatment (2018 version)

As a newly developed technique for hemodynamic monitoring, pulse contour cardiac output (PiCCO) monitoring takes great advantages in guiding shock resuscitation and fluid administration. PiCCO has been used more and more in burn patients in recent years, however there is no clinic consensus on how to apply PiCCO monitoring, understand the significance of PiCCO monitored parameters, and guide the treatment using PiCCO monitored parameters in patients with severe burns. Based on the current literatures and the experts' clinical experience, national experts consensus on application of pulse contour cardiac output monitoring technique in severe burn treatment (2018 version) is now issued by the Burn and Trauma Branch of Chinese Geriatrics Society, aiming to provide practical guidance for its usage in clinic.

Effects of application of pulse contour cardiac output monitoring technology in early treatment of patients with large area burns

Objective: To analyze the changes and relationship of early hemodynamic indexes of patients with large area burns monitored by pulse contour cardiac output (PiCCO) monitoring technology, so as to assess the guiding value of this technology in the treatment of patients with large area burns during shock period. Methods: Eighteen patients with large area burns, confirming to the study criteria, were admitted to our unit from May 2016 to May 2017. Pulse contour cardiac output index (PCCI), systemic vascular resistance index (SVRI), global end-diastolic volume index (GEDVI), and extravascular lung water index (EVLWI) of patients were monitored by PiCCO instrument from admission to post injury day (PID) 7, and they were calibrated and recorded once every four hours. The fluid infusion coefficients of patients at the first and second 24 hours post injury were calculated. The blood lactic acid values of patients from PID 1 to 7 were also recorded. The correlations among PCCI, SVRI, and GEDVI as well as the correlation between SVRI and blood lactic acid of these 18 patients were analyzed. Prognosis of patients were recorded. Data were processed with one-way analysis of variance, single sample ttest and Bonferroni correction, Pearson correlation analysis, and Spearman rank correlation analysis. Results: (1) There was statistically significant difference in PCCI value of patients from post injury hour (PIH) 4 to 168 (F=7.428, P<0.01). The PCCI values of patients at PIH 4, 8, 12, 16, 20, and 24 were (2.4±0.9), (2.6±1.2), (2.2±0.6), (2.6±0.7), (2.8±0.6), and (2.7±0.7) L·min(-1)·m(-2,) respectively, and they were significantly lower than the normal value 4 L·min(-1)·m(-2)(t=-3.143, -3.251, -11.511, -8.889, -6.735, -6.976, P<0.05 or P<0.01). At PIH 76, 80, 84, 88, 92, and 96, the PCCI values of patients were (4.9±1.5), (5.7±2.0), (5.9±1.7), (5.5±1.3), (5.3±1.1), and (4.9±1.4) L·min(-1)·m(-2,) respectively, and they were significantly higher than the normal value (t=2.277, 3.142, 4.050, 4.111, 4.128, 2.423, P<0.05 or P<0.01). The PCCI values of patients at other time points were close to normal value (P>0.05). (2) There was statistically significant difference in SVRI value of patients from PIH 4 to 168 (F=7.863, P<0.01). The SVRI values of patients at PIH 12, 16, 20, 24, and 28 were (2 298±747), (2 581±498), (2 705±780), (2 773±669), and (3 109±1 215) dyn·s·cm(-5)·m(2,) respectively, and they were significantly higher than the normal value 2 050 dyn·s·cm(-5)·m(2)(t=0.878, 3.370, 2.519, 3.747, 3.144, P<0.05 or P<0.01). At PIH 4, 8, 72, 76, 80, 84, 88, 92, and 96, the SVRI values of patients were (1 632±129), (2 012±896), (1 381±503), (1 180±378), (1 259±400), (1 376±483), (1 329±385), (1 410±370), and (1 346±346) dyn·s·cm(-5)·m(2,) respectively, and they were significantly lower than the normal value (t=-4.593, -0.112, -5.157, -8.905, -7.914, -5.226, -6.756, -6.233, -7.038, P<0.01). The SVRI values of patients at other time points were close to normal value (P>0.05). (3) There was no statistically significant difference in the GEDVI values of patients from PIH 4 to 168 (F=0.704, P>0.05). The GEDVI values of patients at PIH 8, 12, 16, 20, and 24 were significantly lower than normal value (t=-3.112, -3.554, -2.969, -2.450, -2.476, P<0.05). The GEDVI values of patients at other time points were close to normal value (P>0.05). (4) There was statistically significant difference in EVLWI value of patients from PIH 4 to 168 (F=1.859, P<0.01). The EVLWI values of patients at PIH 16, 20, 24, 28, 32, 36, and 40 were significantly higher than normal value (t=4.386, 3.335, 6.363, 4.391, 7.513, 5.392, 5.642, P<0.01). The EVLWI values of patients at other time points were close to normal value (P>0.05). (5) The fluid infusion coefficients of patients at the first and second 24 hours post injury were 1.90 and 1.39, respectively. The blood lactic acid values of patients from PID 1 to 7 were 7.99, 5.21, 4.57, 4.26, 2.54, 3.13, and 3.20 mmol/L, respectively, showing a declined tendency. (6) There was obvious negative correlation between PCCI and SVRI (r=-0.528, P<0.01). There was obvious positive correlation between GEDVI and PCCI (r=0.577, P<0.01). There was no obvious correlation between GEDVI and SVRI (r=0.081, P>0.05). There was obvious positive correlation between blood lactic acid and SVRI (r=0.878, P<0.01). (7) All patients were cured except the one who abandoned treatment. Conclusions: PiCCO monitoring technology can monitor the changes of early hemodynamic indexes and volume of burn patients dynamically, continuously, and conveniently, and provide valuable reference for early-stage comprehensive treatment like anti-shock of patients with large area burns.

Assessment of cerebral circulation in a porcine model of intravenously given E. coli induced fulminant sepsis

BackgroundThe aim of the present work was to assess cerebral hemodynamic changes in a porcine model of E.coli induced fulminant sepsis.MethodsNineteen healthy female Hungahib pigs, 10–12 weeks old, randomly assigned into two groups: Control (n = 9) or Septic Group (n = 10). In the Sepsis group Escherichia coli culture suspended in physiological saline was intravenously administrated in a continuously increasing manner according to the following protocol: 2 ml of bacterial culture suspended in physiological saline was injected in the first 30 min, then 4 ml of bacterial culture was administered within 30 min, followed by infusion of 32 ml bacterial culture for 2 h. Control animals received identical amount of saline infusion. Systemic hemodynamic parameters were assessed by PiCCo monitoring, and cerebral hemodynamics by transcranial Doppler sonography (transorbital approach) in both groups.ResultsIn control animals, systemic hemodynamic variables and cerebral blood flow velocities and pulsatility indices were relatively stable during the entire procedure. In septic animals shock developed in 165 (IQR: 60–255) minutes after starting the injection of E.coli solution. Blood pressure values gradully decreased, whereas pulse rate increased. A decrease in cardiac index, an increased systemic vascular resistance, and an increased stroke volume variation were observed. Mean cerebral blood flow velocity in the middle cerebral artery did not change during the procedure, but pulsatility index significantly increased.ConclusionsThere is vasoconstriction at the level of the cerebral arterioles in the early phase of experimental sepsis that overwhelmes autoregulatory response. These results may serve as additional pathophysiological information on the cerebral hemodynamic changes occurring during the septic process and may contribute to a better understanding of the pathomechanism of septic encephalopathy.

Application of transpulmonary thermodilution monitoring (PiCCO) in patient with neurogenic pulmonary edema and acute obstructive hydrocephalus due to a central neurocytoma: A case report

Abstract Neurogenic pulmonary edema (NPE) is an acute life-threatening complication associated with many forms of central nervous system injury. Its pathophysiology is still debated. We report a patient with acute obstructive hydrocephalus due to a central neurocytoma who also had NPE, for which serial transpulmonary thermodilution monitoring (PiCCO) was performed. Insertion of the PiCCO, which provides information about the patient's cardiac output, preload status and amount of lung water, revealed a high pulmonary vascular permeability index (PVPI) and low global end-diastolic volume (GEDV) without cardiac dysfunction, indicating permeability edema, which led to our changing the therapeutic strategy. Using PiCCO monitoring to balance the preload and extent of pulmonary edema enabled achievement of an optimal cardiac preload for organ perfusion, resulting in normalization of pulmonary edema by day 2. PiCCO facilitates understanding of the mechanism of NPE, guiding the management of fluid balance and the choice of vasopressors in patients with life-threatening NPE.

PiCCO监测指导脓毒性休克患者早期目标导向液体治疗的临床研究

PiCCO监测指导脓毒性休克患者早期目标导向液体治疗的临床研究

The Variation of Hemodynamic Parameters Through PiCCO in the Early Stage After Severe Burns.

To investigate early hemodynamics of severely burned patients via PiCCO and to discuss clinical significance of hemodynamic monitoring for burn shock resuscitation, 55 extensive burn patients were enrolled in this retrospective study. The fluid resuscitation was guided according to Chinese General Formula and adjusted with urinary output of 0.5-1.0 ml/h/kg as a resuscitation goal. All patients were diagnosed within a relatively stable condition during burn shock stage, and they received PiCCO monitoring within 6 hours after burn. The preload parameter intrathoracic blood volume index was low at first, then returned to normal. The flow parameter cardiac index and myocardial contractility parameter dPmax were gradually changed from low level in the early stage to high level in the fluid reabsorption stage. The afterload parameter systemic vascular resistance index had completely opposite tendency. The lung-related parameters extravascular lung water index and pulmonary vascular permeability index were roughly in the normal range. The change of cardiac index had a linear regression relationship with dPmax and systemic vascular resistance index but had no significant relationship with intrathoracic blood volume index. Under effective fluid resuscitation, the early hemodynamics after burn is still in dynamically changing status, characterized as transition from low cardiac output (CO)-high vascular resistance in early shock stage to high CO-low vascular resistance in fluid reabsorption stage. CO mainly depends on the myocardial contractility and vascular resistance, but not on the blood volume. Excessive fluid resuscitation cannot get normal CO. The normal value of hemodynamics cannot be used as end point of burn shock resuscitation. Dynamic observation of hemodynamics is of great importance.

Pulse contour cardiac output monitoring in acute heart failure patients : Assessment of hemodynamic measurements.

SummaryBackgroundHeart failure is known to be a major public health problem. Fluid redistribution contributes to acute heart failure; therefore, knowledge of hemodynamic parameters could be important for optimizing outcomes. The pulse contour cardiac output monitor PiCCO uses the single thermal indicator technique and pulse contour analysis to calculate hemodynamic parameters of preload, afterload, cardiac output, systemic vascular resistance and extravascular lung water.ObjectivesWe primarily aimed to describe values and parameters seen in acute heart failure patients admitted to the intensive care unit (ICU) and secondly to investigate associations between hemodynamic measurements and survival data.Material and methodsIn this study 420 consecutive patients admitted to a tertiary medical university hospital ICU between January 2004 and December 2009 were retrospectively investigated. The study sample was divided into two subgroups: patients monitored by PiCCO (n = 47) and those not monitored by thermodilution measurements (n = 373). No predetermined treatment algorithm based on knowledge obtained by the PiCCO monitor was used and measurements were individually interpreted by the treating physician. The PiCCO monitor measurements were carried out according to manufacturer’s directions.ResultsPatients with PiCCO monitoring were clinically in poorer health with a mean simplified acute physiology score II (SAPS2) of 45 ± 17 vs. 56 ± 20 (p < 0.01). The ICU mortality (22 % vs. 38 %, p = 0.02) and, at least as a tendency, long-term-mortality were increased in patients monitored by PiCCO (RR 1.49, 95 % CI 0.96–2.31, p = 0.08). We provide hemodynamic measurements in acute heart failure patients: cardiac index (2.7 ± 1.2 l/min/m²) was reduced, preload and extravascular lung water index (EVLWI, 11.5 ± 5.1 ml/kg body weight), representing lung edema, were increased.ConclusionWe provide real world values for PiCCO parameters in acutely decompensated heart failure. In our study patients who were clinically in poorer health were monitored with PiCCO, resulting in increased mortality in this group. Further prospective studies to investigate the effects of treatment decisions triggered by information obtained by PiCCO monitoring for patients in acute heart failure are needed.