PiCCO monitoring during anesthesia

Introduction

The Pulse Contour Cardiac Output (PiCCO) is an innovative technology that monitors the cardiac preload volume through the global end diastolic volume (GEDV) and gives an extimation of the intrathoracic blood volume, an indicator of circulating volume and of the extravascular lung water (EVLWI), which is considered to be a good extimator of interstitial lung edema. Moreover PiCCO, through a `beat to beat' analysis of the arterial pressure wave, measures continuous cardiac output. The aim of this study is to evaluate the new volumetric hcmodynamic monitoring during major surgery and during liver and lung transplantation (Tx).

Methods

After approval from ethical committee 41 patients undergoing lung transplantation (11), liver transplantation (10), thoracic surgery (10) and major abdominal surgery (10) were included in the study. In all pts were placed a Swan-Ganz catheter (IntelliCath-Baxter, Irvine CA-USA, connected to Vigilance Monitor-Baxter) and a 4 F fiberoptic-thermistor catheter was inserted into the femoral or brachial artery (Pulsion PiCCO-Medi-zimechnik, Munchen). Hemodynamic volumetric data were collected in different phases: during lung Tx (MV = after induction of anesthesia; (CL1 = after the first pulmonary artery clamping; REP1 = after the reperfusion of the first lung; CL2 = after the second pulmonary artery clamping; REP2 = after the reperfusion of the second lung; Fin end of surgery); during liver Tx (A = after induction of anesthesia; B = anephatic phase; C = end of surgery); during thoracic (A = after induction of anesthesia; B = during surgery in one lung ventilation; C- end of surgery) and abdominal surgery (A = after induction of anesthesia; B = during surgery; C = end of surgery).

Results

See Table.

Discussion

Other authors reported GEDV modifications correlated to cardiac index rather than standard cardiac filling pressures such as CVP and PAWP, so chat GEDV is considered a `pure' volume indicator. EVLWI can be considered a potential indicator of lung damage and pulmonary function, and it is hypothesized to be a better endpoint than PAWP during fluid management.

In conclusion monitoring EVLWI, as pulmonary edema indicator and GEDV, as cardiac preload value, lead our diagnostic and terapeutic management during major surgical procedures.

Table 1