The PiCCO system: feasibility and complications of its use in paediatric intensive care

Background and objectives

The PiCCO system provides haemodynamic evaluation and monitoring, using two different techniques: transpulmonar peripheric arterial thermodilution and pulse contour analysis. Paediatric literature is still limited. We retrospectively analysed the use of the PiCCO system in our paediatric intensive care unit, focusing on its feasibility and complications.

Results

During 16 months, we have used 26 Pulsiocath^® (mean patient weight 24 kg and age 80 months) versus 126 arterial catheters (mean patient weight 15 kg and age 40 months). Complications are presented in Table 1 (major complications include thrombosis, peripheral necrosis and general infection; minor complications include obstruction, temporary ischaemia or oedema and local infection).

Table 1

Feasibility

The first values could be measured on average 1 hour after the decision of haemodynamic monitoring had been taken. The use of the PiCCO system failed twice: once the patient died before the first measures, and once because of an arterial stenosis due to a previous catheterization. We encountered technical difficulties with the 3 F Pulsiocath^®, because of its weakness.

Conclusions

The rates of complications are acceptable, in our population characterized by haemodynamic dysfunction and small artery diameters (two parameters known as risk factors for arterial catheterization complication). Its feasibility is good, and technical failure is rare. This technique therefore appears interesting in paediatrics and moderately invasive, compared with other techniques allowing haemodynamic monitoring. It encourages us to extend its use in the paediatric population.