Advantages and Limitations of PiCCO
Indications for use of PiCCO:
- Guidance of fluid management in patients with complex hemodynamic failure, eg. combination septic and cardiogenic shock
- Unavailability of, or contraindications to, the use of PA catheters
Contraindications for use of PiCCO:
- Atrial or ventricular arrhythmia: you need a stable pulse to measure the contour of
- Intra-Aortic Balloon pump: once again, the pulse contour is all wrong; but you can still get thermodilution cardiac output measurements.
- Aortic aneurysm: the contour will be bizarre because the arterial compliance is going to be weird, with the aortic aneurysm acting as a damping system by absorbing all the pressure wave.
- Extracorporeal circuit: when you are on bypass, there is no real arterial waveform
- Pneumonectomy: PiCCO relies on there being a relatively normal pulmonary vasculature
- Massive pulmonary embolism: as above; it is essentially a pneumonectomy by embolism.
- Intracardiac shunt: the PA catheter will also give an inaccurate thermodilution reading