Current practice of hemodynamic monitoring with PiCCO in a single general surgical ICU in a university hospital - a short report

Background: In recent years, there has been an overall trend toward using less in-vasive hemodynamic monitoring in surgi-cal intensive care units. The pulse contour cardiac output monitor (PiCCO) is one of them. 

Objectives: The aim of this study was to evaluate our practice of hemodynamic monitoring with PiCCO in the periopera-tive period. 

Methods: A retrospective descriptive analysis was performed in a single general surgical intensive care unit (ICU) run by anesthesiologists for the years 2013-2016. We collected information about patients, ICU quality parameters and monitoring equipment available in the ICU. The pri-mary endpoint was the incidence of PiC-CO use. 

Results: Out of 2972 patients admitted to the general surgical ICU in a 4-year pe-riod, besides basic monitoring with elec-trocardiography (ECG), pulse oximetry and blood pressure monitoring, more than half of the patients received central venous catheterization (55.1%), less than the half invasive arterial catheterization (44.1 %) and only a small proportion PiCCO (0.91%). No patient received a pulmonary arterial catheter. Mortality rate was 7.47 %. Conclusion: The use of PiCCO in our ICU is far below reported in literature. In the majority of cases, our anesthesiologists make clinical decisions based on measure-ment of central venous and invasive arte-rial pressure.

hemodynamic monitoring, in-tensive care unit, general surgery

1. Saugel B, Malbrain ML, Perel A. Hemodynamic monitoring in the era of evidence-based medicine. Crit Care 2016;20:401.

2. Watson X, Cecconi M. Hemodynamic monitoring in the perioperative period: the past, the present and the future. Anaesthesia 2017;72(Suppl 1):7-15.

3. Geisen M, Rhodes A, Cecconi M. Less-invasive approaches to perioperative hemodynamic optimization. Curr Opin Crit Care 2012;18:377-84.

4. About Pulsion history. [cited 2017 Jan 31] Available from: http://www.pulsion.com/international-english/company/about-pulsion/history/.

5. Bellomo R, Uchino S. Cardiovascular monitoring tools: use and misuse. Curr Opin Crit Care 2003;9:225-9.

6. Wernly B, Lichtenauer M, Franz M, Fritzenwanger M, Kabisch B, Figulla HR, et al. Pulse contour cardiac output monitoring in acute heart failure patient: Assessment of hemodynamic measurements. Wien Klin Wochenschr 2016;128:864-9. 

7. MutohT, KazumataK, IshikawaT, Terasaka S. Performance of bedside transpulmonary thermodilution monitoring for goal-directed hemodynamic management after subarachnoid hemorrhage. Stroke 2009;40:2368–74.

8. Yamada T, Tsutsui M, Sugo Y, Sato T, Akazawa T, Sato N, et al. Multicenter study verifying a method of noninvasive continuous cardiac output measurement using pulse wave transit time: a comparison with intermittent bolus thermodilution cardiac output. Anesth Analg 2012;115:82-7.

9. Yuanbo Z, Jin W, Fei S, Liangong L, Xunfa L, Shihai X, et al. ICU management based on PiCCO parameters reduces duration of mechanical ventilation and ICU length of stay in patients with severe thoracic trauma and acute respiratory distress syndrome. Ann Intensive Care 2016;6:113.

10. 1Funcke S, Sander M, Goepfert MS, Groesdonk H, Heringlake M, Hirsch J, et al. ICU-CardioMan Investigators. Practice of hemo-dynamic monitoring and management in German, Austrian, and Swiss intensive care units: the multicenter cross-sectional ICU-CardioMan Study. Ann Intensive Care 2016;6:49.

11. Gidwani UK, Goel S. The Pulmonary Artery Catheter in 2015: The Swan and the Phoenix. Cardiol Rev 2016;24:1-13.

12. Vincent JL, Pelosi P, Pearse R, Payen D, Perel A, Hoeft A, et al. Perioperative cardiovascular monitoring of high-risk patients: a con-sensus of 12. Crit Care 2015;19:224.

13. Vincent JL, Rhodes A, Perel A, Martin GS, Della Rocca G, Vallet B, et al. Clinical review: update on hemodynamic monitoring—a consensus of 16. Crit Care 2011;15:229.

14. Cecconi M, De Backer D, Antonelli M, Beale R, Bakker J, Hofer C, et al. Consensus on circulatory shock and hemodynamic monitor-ing. Task force of the European Society of Intensive Care Medicine. Intensive Care Med 2014;40:1795–815.

15. Cannesson M, Pestel G, Ricks C, Hoeft A, Perel A. Hemodynamic monitoring and management in patients undergoing high risk surgery: a survey among North American and European anesthesiologists. Crit Care 2011;15:R197

16. Boulain T, Boisrame-Helms J, Ehrmann S, Lascarrou JB, Bouglé A, Chiche A, et al. Volume expansion in the first 4 days of shock: a prospective multicentre study in 19 French intensive care units. Intensive Care Med 2015;41:248-56.

17. Preau S, Dewavrin F, Demaeght V, Chiche A, Voisin B, Minacori F, et al. The use of static and dynamic hemodynamic parameters be-fore volume expansion: A prospective observational study in six French intensive care units. Anaesth Crit Care Pain Med 2016;35:93-102.

18. Hofkens PJ, Verrijcken A, Merveille K, Neirynck S, Van Regenmortel N, De Laet I, et al. Common pitfalls and tips and tricks to get the most out of your transpulmonary thermodilution device: results of a survey and state-of-the-art review. Anaesthesiol Intensive Ther 2015;47:89-116.

19. Feltracco P, Biancofiore G, Ori C, Saner FH, Della Rocca G. Limits and pitfalls of hemodynamic monitoring systems in liver trans-plantation surgery. Minerva Anestesiol 2012;78:1372-84.

20. Siegenthaler N, Giraud R, Saxer T. Hemodynamic monitoring in the intensive care unit: results from a Web-Based Swiss Survey. Biomed Res Int 2014;Volume 2014, Article ID 129593, 9 pages, http://dx.doi.org/10.1155/2014/129593.