Transpulmonary thermodilution (PiCCO) measurements in children without cardiopulmonary dysfunction: large interindividual variation and conflicting reference values

Abstract

Values obtained by the PiCCO system in children have a wide range, and should therefore be interpreted with caution. Current reference values published for GEDVI and EVLWI are not applicable in children; the former is too high and the latter too low, and should not guide clinical practice. Indexing by other physiological indices may reduce this problem. Using current variables, we find GEDVI 280-590 ml · m(-2) and ELWI 7-27 ml · kg(-1) to be typical ranges for children.

Hemodynamic evaluation of anesthetized baboons and piglets by transpulmonary thermodilution: Normal values and interspecies differences with respect to xenotransplantation

“…In contrast, ELWI is higher in both baboons and infant pigs than in adult humans (3‐7 mL/kg). Low GEDI and high ELWI values have also been reported for other animals and human infants: In pediatric patients (n = 101 children, age 0‐18 years), median GEDI was between 366 and 479 mL/m 2 and median ELWI between 10 and 12 mL/kg . In Maryland minipigs (n = 38, 8‐16 kg), López‐Herce et al observed mean values of 198 mL/m 2 for GEDI and 16 mL/kg for ELWI, respectively .…”

Indexing haemodynamic variables in young children

“…In young children, BW was a more appropriate indexing alternative routine to index the values according to BSA. [19][20][21] These studies have…”

“…Several efforts have been made to achieve haemodynamic reference values in young children in the past, but the cohorts are often small and based on the accepted routine to index the values according to BSA. [19][20][21] These studies have shown that the use of BSA as an index, or normalization, is still unsupported by data in infants and that the exponential relationship between BSA and some haemodynamic variables in smaller children needs to be explained. 22,23 This is supported by the exponential increase in the BSA/weight ratios that occurs in smaller children (Figure 2).…”

“…At the same time, it has been noticed that volume variables tend to follow a more linear relationship with BW. Several efforts have been made to achieve haemodynamic reference values in young children in the past, but the cohorts are often small and based on the accepted routine to index the values according to BSA 19‐21 . These studies have shown that the use of BSA as an index, or normalization, is still unsupported by data in infants and that the exponential relationship between BSA and some haemodynamic variables in smaller children needs to be explained 22,23 .…”

Use of CO2-Derived Variables in Cardiac Intensive Care Unit: Pathophysiology and Clinical Implications

“…Some catheters, such as the PICCO™ device, can continuously monitor CO. However, despite very promising data on the applicability and validity of the CO measure devices, the invasiveness and relative difficulties of use probably limit their use in the setting of clinical trials [46][47][48][49]. A more recent tool for CO measurement is represented by electrical bioimpedance.…”