The PiCCO Monitor: A Review

Abstract

Advanced haemodynamic monitoring remains a cornerstone in the management of the critically ill. While rates of pulmonary artery catheter use have been declining, there has been an increase in the number of alternatives for monitoring cardiac output as well as greater understanding of the methods and criteria with which to compare devices. The PiCCO (Pulse index Continuous Cardiac Output) device is one such alternative, integrating a wide array of both static and dynamic haemodynamic data through a combination of trans-cardiopulmonary thermodilution and pulse contour analysis. The requirement for intra-arterial and central venous catheterisation limits the use of PiCCO to those with evolving critical illness or at high risk of complex and severe haemodynamic derangement. While the accuracy of trans-cardiopulmonary thermodilution as a measure of cardiac output is well established, several other PiCCO measurements require further validation within the context of their intended clinical use. As with all advanced haemodynamic monitoring systems, efficacy in improving patient-centred outcomes has yet to be conclusively demonstrated. The challenge with PiCCO is in improving the understanding of the many variables that can be measured and integrating those that are clinically relevant and adequately validated with appropriate therapeutic interventions.

Fluid Resuscitation of Adults With Severe Falciparum Malaria

“…The physiological basis for measurement of hemodynamic variables using the PiCCO system is described in detail elsewhere (17,18). PiCCO-determined variables included the following: cardiac index (CI), global end-diastolic volume index (GEDVT), a measure of volume status; extravascular lung water index (ELWI), a measure of pulmonary edema; and pulmonary vascular permeability index (PVPI), a measure of pulmonary capillary leak.…”

Prediction of pulmonary edema by plasma protein levels in patients with sepsis

“…Then an amount of 15-to 20-mL normal saline at a temperature less than 8°C was injected via central venous catheter, and various hemodynamic parameters could be obtained through analysis of variations in blood temperature taken by the temperature sensor of the arterial catheter. The calculations of PiCCO-related hemodynamic parameters had been described in detail elsewhere [11]. Briefly, the extravascular lung water (EVLW) was calculated by subtracting intrathoracic blood volume from intrathoracic thermal volume, and extravascular lung water index (EVLWI) was calculated by indexing EVLW to body weight.…”

ICU management based on PiCCO parameters reduces duration of mechanical ventilation and ICU length of stay in patients with severe thoracic trauma and acute respiratory distress syndrome

“…PiCCO is a minimally invasive technique and allows the monitoring of beat-by-beat cardiac output. In addition, volume status and pulmonary edema can be monitored, as well as the hemodynamic status [6]. The PiCCO system also allows for extravascular lung water (EVLW) monitoring [7].…”