PiCCO

1. PiCCO – PULSE induced
CONTOUR CARDIAC
OUTPUT

2.  Indications in ICU
 Haemodynamic instability
 Shock (cardiogenic shock)
 Sepsis
 Lung injury
 Pulmonary oedema
 Organ failure

3. Cardiogenic shock
The haemodynamic profile of low cardiac output, hypotension
and severe pulmonary congestion arising from an acute
disturbance in cardiac function is termed cardiogenic shock.
Specific definition of cardiogenic shock includes:-
 Cardiac index less than 2.1
 Systolic blood pressure less than 90
 Pulmonary capillary wedge pressure greater than 18
 Additional parameters include
 Intra-thoracic blood volume index greater than 850
 Global end diastolic volume greater than 700
 Extra vascular lung volume index greater than 10.

4. Contraindications for PiCCO can classified
under 2 categories
 Contraindication to vascular device insertion
including peripheral vascular disease, arterial
grafting, overlaying infection and
coagulopathy
 Anatomical or physiological derangements
such as patients having constant cardiac
arrhythmias , aortic valve pathology
 Others :-
 patients on circulatory assist device
 unreliable arterial waveform (positional)

5. PARAMETERS MEASURED IN PiCCO
Stroke volume
Based on the demographic data and arterial waveform details an
individual calibration factor is computed as the automatic start
value – CO. Then pulmonary contour analysis is performed
from the arterial pressure curve. Stroke volume is analysed and
calibrated by comparing the systolic area with the start value -
CO
Stroke Volume is reflected by the area under the systolic part of
the pressure
curve (red area) of one heart beat.

6. Stroke volume
Stroke volume is the amount of blood
ejected by the right ventricle in one
contraction. It is calculated using the
following formula
Stroke volume (SV) = (Cardiac output x 1000) / Heart rate
For example, patient with a hear rate of 75beats/minute and cardiac out put
of 5litres / minute stroke volume is calculated as below
SV = (5 X 1000) / 75 = 66.67ml/beat

7. Stoke volume variation - SVV
 Changes in stroke volume over the
respiratory cycle
 SVV should be less than 10%. High SVV
triggers fluid resuscitation.
SVV are only applicable in patients on
fully controlled mechanical ventilation and in
regular rhythm with tidal volume at least 8ml/kg.

8.  Cardiac Index
 Volume of blood pumped by the heart in
one minute indexed to body surface area.
 CI = 3 – 5 l/min/m2

9. Stoke volume index
 Volume pumped by the heart during one
heart beat indexed to BSA
 SVI = 40 – 60 ml/m2

10. GEDVI – global end diastolic volume
index
 Volume of blood contained in the four
chambers of the heart indexed to BSA.
 GEDVI – 680 – 800 ml/m2

11. Intra-thoracic blood volume index
Volume of blood contained in the four
chambers of the heart plus blood volume in
the pulmonary blood vessels indexed to
BSA.
ITBVI – 850 – 1000 ml/m2

12. Extra vascular lung water index
The amount of water content in the lungs;
allows quantification of the degree of
pulmonary oedema
EVLWI – 3 – 7ml/kg.

13. SVRI = 1700 to 2400 dyn x sec x cm-5 x m2
Systemic vascular resistance index
Resistance the heart has to overcome to eject blood.
SVRI helps to differentiate and optimize vasopressor therapy.