Transpulmonary thermodilution techniques in the haemodynamically unstable patient.

PURPOSE OF REVIEW

Transpulmonary thermodilution (TPTD) devices invasively measure not only cardiac output but also several other haemodynamic variables estimating cardiac preload, cardiac preload, systolic function, the lung oedema and systolic function, the lung oedema and the pulmonary permeability. In light of the recent literature, we describe how different indices are measured, emphasize their clinical interest and list potential limits and side-effects of the technique.

RECENT FINDINGS

Estimation of cardiac output measurement with TPTD is now well established, at least when compared with the pulmonary artery catheter. The advantage of calibrating the pulse contour analysis, as it is allowed by TPTD indices, is clearly established over uncalibrated devices. The greatest advantage of TPTD is to measure extravascular lung water and pulmonary permeability, which may be useful to diagnose acute respiratory distress syndrome and manage fluid therapy in various critical diseases. It also allows a rapid detection of left ventricular systolic failure. The information it provides must be considered complementary to that provided by echocardiography.

SUMMARY

TPTD provides several indices that may help in making decisions during the therapeutic management of haemodynamically unstable patients. It should be used for the most critically ill patients, whose management requires a reliable, precise and holistic view of the cardiopulmonary condition.