Volumetric haemodynamic monitoring and continuous pulse contour analysis – an untapped resource for coronary and high dependency care units?

Critically ill patients in the coronary care or high dependency units (CCU, HDU) need accurate assessment of their haemodynamic status to guide fluid or vasoactive drug therapy. Both central venous pressure and pulmonary artery occlusion pressure are poor guides to cardiac filling and pulmonary oedema, and using a pulmonary artery catheter often fails to improve clinical outcome.
The PiCCO system is a relatively new and less invasive approach to cardiac monitoring. It has been used extensively in intensive care and is reviewed in this article. This approach uses thermo-dilution techniques to reliably calculate volumetric measurements of cardiac preload and cardiac output, and can provide continuous real-time cardiac output and stroke volume variation measurements through pulse contour analysis. The reliability and accuracy of this method has drastically refined fluid and vasopressor management of the hypotensive patient and the management and prevention of pulmonary oedema. This method of measuring cardiac output correlates well with gold standard methods of cardiac output calculation and has been validated in adults and children.
The PiCCO system can be an invaluable tool in the optimisation of the circulation in cardiac, medical and surgical patients commonly seen in the CCU and HDU.