PiCCO-guided Resuscitation of Shock
There are three main variable to look at when one is using the PICCo to guide the resuscitation of ashock. It comes down to a simple question: do I give them more fluids, or do I crank up the norad?
The three cardinal variables:
- Cardiac Index (CI)
- Intrathoracic blood volume index (ITBVI)
- Extravascular lung water index (EVLWI)
Look at the cardiac index.
- Is it high or low?
Low cardiac index: what is the ITBVI?
- If there is not enough intrathoracic blood volume, you need to fill your patient.
- Ask of your PiCCO: is there already too much EVLW? Can I give more fluids safely without flooding the patients lungs?
- If there is enough ITBVI, you cant really expect a fluid bolus to improve cardiac output. You need inotropes.
High or normal cardiac index: what is the ITBVI?
- If your patient is shocked with a high cardiac index, this looks more like a septic vasodilated picture.
- Still, one ought to try filling them up before going to vasopressors.
- If the ITBVI is low, give fluids.
- If the ITBVI is high, start vasopressors – you patient is well filled.
- If the ITBVI is low and the EVLWI is high, you have overdone it with the fluids.