Transpulmonary thermodilution measurements are not affected by continuous veno-venous hemofiltration at high blood pump flow

Dufour, Nicolas; Delville, Marianne; Teboul, Jean‐Louis; Camous, Laurent; Noyer, Aude Favier du; Richard, Christian; Monnet, Xavier

doi:10.1007/s00134-012-2573-5

Cited by 25 publications

(25 citation statements)

References 18 publications

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“…The calibration should be performed at least every 8 hours, or following a major change in a patient’s clinical condition [23]. To exclude variations in blood volume and temperature caused by continuous renal replacement therapy (CRRT), the calibration will not be performed immediately after CRRT is switched on or off, and the measurement can be performed after the blood temperature reaches a steady state (after two minutes) [24,25]. …”

Section: Methodsmentioning

confidence: 99%

Use of the PiCCO system in critically ill patients with septic shock and acute respiratory distress syndrome: a study protocol for a randomized controlled trial

Zhang

Yao

et al. 2013

Trials

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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

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Section: Methodsmentioning

confidence: 99%

Use of the PiCCO system in critically ill patients with septic shock and acute respiratory distress syndrome: a study protocol for a randomized controlled trial

Zhang

Yao

et al. 2013

Trials

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“…The technique cannot be used in case of extracorporeal membrane oxygenation. By contrast, continuous veno-venous haemofiltration does not affect the reliability of cardiac output measurement by TPTD [12–14], even for high blood pump flows [13]. The thermistor-tipped catheter is most often inserted in the femoral artery, but the axillary, brachial and radial (long catheter) arteries may also be used, although this requires that the elbow remains in the extended position.…”

Section: Measurement Of Cardiac Outputmentioning

confidence: 99%

“…Nevertheless, a study found that, by contrast, removing pleural effusion increased EVLW, perhaps by alleviating atelectasis in contact with the pleural effusion [67]. As for cardiac output or GEDV, renal replacement therapy [12, 13] and therapeutic hypothermia [6] do not alter the measurement of EVLW.…”

Section: Cardiac Systolic Functionmentioning

confidence: 99%

Transpulmonary thermodilution: advantages and limits

2017

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Background: For complex patients in the intensive care unit or in the operating room, many questions regarding their haemodynamic management cannot be answered with simple clinical examination. In particular, arterial pressure allows only a rough estimation of cardiac output. Transpulmonary thermodilution is a technique that provides a full haemodynamic assessment through cardiac output and other indices. Main body: Through the analysis of the thermodilution curve recorded at the tip of an arterial catheter after the injection of a cold bolus in the venous circulation, transpulmonary thermodilution intermittently measures cardiac output. This measure allows the calibration of pulse contour analysis. This provides continuous and real time monitoring of cardiac output, which is not possible with the pulmonary artery catheter. Transpulmonary thermodilution provides several variables beyond cardiac output. It estimates the end-diastolic volume of the four cardiac cavities, which is a marker of cardiac preload. It provides an estimation of the systolic function of the combined ventricles. It is more direct than the pulmonary artery catheter, but does not allow the distinct estimation of right and left cardiac function. It is easier and faster to perform than echocardiography, but does not provide a full evaluation of the cardiac structure and function. Transpulmonary thermodilution has the unique advantage of being able to estimate at the bedside extravascular lung water, which quantifies the volume of pulmonary oedema, and pulmonary vascular permeability, which quantifies the degree of a pulmonary capillary leak. Both indices are helpful for guiding fluid strategy, especially in case of acute respiratory distress syndrome. Conclusions: Transpulmonary thermodilution provides a full cardiovascular evaluation that allows one to answer many questions regarding haemodynamic management. It belongs to the category of "advanced" devices that are indicated for the most critically ill and/or complex patients.

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“…The measurement of CO by transpulmonary thermodilution has been demonstrated to be not only accurate but also precise [30]. The reliability is not altered in patients with renal replacement therapy, even at high blood flows [31]. The analysis of the thermodilution curve also provides other hemodynamic variables.…”

Section: Transpulmonary Thermodilutionmentioning

confidence: 98%

Monitoring

Jozwiak

Monnet

Teboul

2015

Current Opinion in Critical Care

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Transpulmonary thermodilution measurements are not affected by continuous veno-venous hemofiltration at high blood pump flow

Abstract: CVVH with a high blood flow pump does not alter the transpulmonary thermodilution measurements of CI, GEDVI, and EVLWI.

Cited by 25 publications

References 18 publications

Use of the PiCCO system in critically ill patients with septic shock and acute respiratory distress syndrome: a study protocol for a randomized controlled trial

Use of the PiCCO system in critically ill patients with septic shock and acute respiratory distress syndrome: a study protocol for a randomized controlled trial

Transpulmonary thermodilution: advantages and limits

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