Advantages and Limitations of PiCCO

Created on Mon, 06/29/2015 - 18:40
Last updated on Mon, 06/29/2015 - 18:41

 

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

 

References

From Bersten and Soni’s” Oh's Intensive Care Manual”, 6th Edition, as well as http://www.pulsion.com/ who are sadly the best source for this sort of information.