PiCCO-guided Resuscitation of Shock

Created on Mon, 06/29/2015 - 18:52
Last updated on Mon, 06/29/2015 - 18:53
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.
  • Thus:
    • 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.



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.