Department of Pediatrics, Division of Critical Care Medicine, Hôpital Sainte-Justine, Université de Montréal, Montréal, Canada.
Pediatr Crit Care Med. 2011 Jul;12(4):459-66. doi: 10.1097/PCC.0b013e3182070959.
To summarize the physiologic principles underlying the hemodynamic monitoring using the PiCCO device (Pulsion, Munich, Germany) incorporating the transpulmonary thermodilution technique, the pulse contour cardiac output, and estimation of the arterial pressure variation method. Analysis and review of the current literature.
A MEDLINE-based literature search using the key words transpulmonary thermodilution, pulse contour analysis, cardiac output, animal models, and child.
The bias and precision of cardiac output measured by transpulmonary thermodilution are reliable. The reproducibility for repeated measurements is approximately 5% and the percentage error is approximately 15%. Transpulmonary thermodilution may adequately track changes in cardiac output in animals submitted to hypovolemic conditions and during volume loading. Conversely, data from experimental and clinical studies suggest that continuous monitoring of cardiac output using pulse contour analysis requires careful interpretation because periodic recalibration with transpulmonary thermodilution is necessary. Transpulmonary thermodilution-derived static indicator of cardiac preload (global end-diastolic volume, intrathoracic blood volume) may be more sensitive than conventional measurements of vascular filling pressure. However, the value of stroke volume variation or pulse pressure variation have not been evaluated in pediatric patients. Further studies are needed to determine whether theoretical assumptions underlying the measurement of extravascular lung water are valid in children.
The PiCCO device may be a useful adjunct for hemodynamic monitoring in critically ill children. Further studies are needed to clarify the reliability and clinical value of pulse contour method and extravascular lung water measurement.
总结基于经肺温度稀释技术、脉搏轮廓心输出量和动脉压变异估计法的 PiCCO 设备（德国慕尼黑 Pulsion）进行血流动力学监测的生理原理。对当前文献进行分析和综述。
使用关键词经肺温度稀释、脉搏轮廓分析、心输出量、动物模型和儿童，基于 MEDLINE 进行文献检索。
经肺温度稀释法测量心输出量的偏倚和精度可靠。重复测量的可重复性约为 5%，误差百分比约为 15%。经肺温度稀释法可充分跟踪低血容量状态和容量负荷期间动物心输出量的变化。相反，来自实验和临床研究的数据表明，使用脉搏轮廓分析连续监测心输出量需要仔细解释，因为需要定期用经肺温度稀释法重新校准。经肺温度稀释法衍生的心脏前负荷静态指标（全心舒张末期容积、胸腔内血容量）可能比传统的血管充盈压测量更敏感。然而，在儿科患者中，尚未评估每搏量变异或脉搏压变异的价值。需要进一步研究以确定测量肺外水的理论假设在儿童中是否有效。
PiCCO 设备可能是危重症儿童血流动力学监测的有用辅助手段。需要进一步研究以阐明脉搏轮廓法和肺外水测量的可靠性和临床价值。
