Hemodynamic monitoring by transpulmonary thermodilution and pulse contour analysis in critically ill children

OBJECTIVES: To summarize the physiologic principles underlying the hemodynamic monitoring using the PiCCO device (Pulsion, Munich, Germany) incorporating the transpulmonary thermodilution technique, the pulse contour cardiac output, and estimation of the arterial pressure variation method. Analysis and review of the current literature. DESIGN: A MEDLINE-based literature search using the key words transpulmonary thermodilution, pulse contour analysis, cardiac output, animal models, and child. MEASUREMENTS AND MAIN RESULTS: The bias and precision of cardiac output measured by transpulmonary thermodilution are reliable. The reproducibility for repeated measurements is approximately 5% and the percentage error is approximately 15%. Transpulmonary thermodilution may adequately track changes in cardiac output in animals submitted to hypovolemic conditions and during volume loading. Conversely, data from experimental and clinical studies suggest that continuous monitoring of cardiac output using pulse contour analysis requires careful interpretation because periodic recalibration with transpulmonary thermodilution is necessary. Transpulmonary thermodilution-derived static indicator of cardiac preload (global end-diastolic volume, intrathoracic blood volume) may be more sensitive than conventional measurements of vascular filling pressure. However, the value of stroke volume variation or pulse pressure variation have not been evaluated in pediatric patients. Further studies are needed to determine whether theoretical assumptions underlying the measurement of extravascular lung water are valid in children. CONCLUSIONS: The PiCCO device may be a useful adjunct for hemodynamic monitoring in critically ill children. Further studies are needed to clarify the reliability and clinical value of pulse contour method and extravascular lung water measurement