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Summary
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.
Key Words: monitoring, haemodynamic, cardiac output, PiCCO monitor
Advanced haemodynamic monitoring has remained a cornerstone in the management of the critically ill since the introduction of the pulmonary artery catheter into clinical practice in the 1970s1. The pulmonary artery catheter is still to a large extent the clinical reference standard for cardiac output measurement, but its utility is increasingly questioned and use appears to be declining2,3. Technological advances coupled with both the recognition of costs4, complications5 and a failure to demonstrate mortality benefit6,7 with the pulmonary artery catheter has driven the demand for less invasive alternatives.
Despite a substantial increase in the number of publications comparing haemodynamic monitoring devices8, there are several reasons why their appropriate role in clinical practice remains uncertain. First, cardiac output and other advanced haemodynamic measurements can be derived through a variety of unrelated methods, each with important benefits and limitations requiring consideration. Second, the aortic flow probe as the accepted gold standard for cardiac output measurement is impractical and highly invasive and in the clinical setting is substituted for a reference device with known...