Picco

PULSION PiCCO
plus
OCT - 04
RAZONES PARA CONOCER UN MTODO NUEVO
DE MONITORIZACIN HEMODINMICA
Ventajas e! PiCCO
Cat"te# TD$ P#e%isa &en's tie&(' e %'!'%a%i)n* (+ee &antene#se
,asta -0 .as * &anej' si&(!e / #0(ia / tie&(' e #es(+esta %'#t'
Siste&a e &ei%i)n in0&i%' 1!ati' a !ati'23 &en's in4asi4'3 sin
ne%esia e %atete#i5a# e! %'#a5)n e#e%,'
Re+%%i)n e !a estan%ia en !a UCI /
e%'n)&i%a
Pa#0&et#'s e a(!i%a%i)n %!.ni%a i#e%ta3 sin ne%esia e
inte#(#eta%i)n
C+anti6i%a%i)n e! a7+a (+!&'na#
e8t#a4as%+!a#
Meia e 6!+j'3 (#e%a#7a3 ('st%a#7a /
%'nt#a%ti!ia
90%i! e a(!i%a# en (a%ientes
(ei0t#i%'s
CATETER DE ARTERIA PULMONAR$ UN DE:ATE A:IERTO
Dese -;<0 se ,an +sa' &0s e 4= &i!!'nes e CAP
M0s e >000 (+?!i%a%i'nes en !a !ite#at+#a &"i%a
En -;;@ C'nn'#s / %'!a?'#a'#es es%#i?en !a as'%ia%i)n ent#e
e! +s' e CAP / +n &a/'# #ies7' e &+e#te
En +n est+i' #e%iente #an'&i5a' e! CAP n' e&'st#)
?ene6i%i'$ San,a& AD3 N En7! AB Me C00>B
Est+i's e6i%ientes ('# #an'&i5a%i)n inae%+aa3 ta&aD' e
!a &+est#a ins+6i%iente3 (#esen%ia e en6e#&eaes / te#a(ias
%'n%'&itantes / est+i' &a! iseDa'
Ot#'s est+i's ,an s+7e#i' #es+!ta's ('siti4's %'n !a
&'nit'#i5a%i)n %'n CAP$ S,'e&aEe# FC,est -;GGH3 :'/D FAa&a
-;;>H3 Min'5 FC#it Ca#e Me -;;4H3 I4an'4 FNeI H'#i5'n -;;<HB
CATETER DE ARTERIA PULMONAR$ UN DE:ATE A:IERTO FIIH
A 4e%es3 e! %'n'%i&ient' e aJ+e!!'s J+e +san !'s CAP es
in%'nsistente e inae%+a'$ SJ+a#a FC,est C00CH3 I?e#ti FAa&a
-;;0H3 Aa%Ea FC#it Ca#e Me C00CH
L's #es+!ta's &ej'#an %+an' e! CAP es +ti!i5a' ('#
(e#s'na! %'n ?+en %'n'%i&ient' e !a t"%ni%a$ Knae7i FC#it
Ca#e Me -;;<H
C'n6e#en%ia C'nsens' s'?#e Ca( FC#it Ca#e Me -;;<H
C'n%!+si)n$
E! e8a&en %!.ni%' (a#e%e +n 1('?#e2 (#ei%t'# ,e&'in0&i%' 3 !as
i4e#sas t"%ni%as e &'nit'#i5a%i)n s'n ,e##a&ientas
ia7n)sti%as / e! (#in%i(a! ete#&inante e s+s #es+!ta's
('siti4's es !a t'&a %'##e%ta e e%isi'nes s'?#e e! t#ata&ient'
INTRODUCCION HISTORICA
PICCO es +n a(a#at' iseDa' (a#a e! &anej' ,e&'in0&i%' /
4'!+&"t#i%' e! (a%iente3 J+e (e#&ite &ei# t#es (a#0&et#'s
#e!ati4a&ente n+e4's$ IT:V3 EVLL / C9I
C'&?ina 's t"%ni%as$ TD t#ans(+!&'na# / an0!isis e!
%'nt'#n' e! (+!s'
-;@0$ S+#7e !a iea e +sa# e! %a!'# %'&' ini%a'# (a#a &ei#
e! KC
-;@@$ Des%#i(%i)n e !a t"%ni%a e i!+%i)n e '?!e ini%a'#
FEIa#sH
-;<0$ Est+i's e 4a!ia%i)n %'n6i#&an J+e !a te#&'i!+%i)n
inte#&itente / !a i!+%i)n D/E s'n inte#%a&?ia?!es
M"t'' e&(!ea' ('# ICCO$ TD si&(!e t#ans(+!&'na#
INTRODUCCION HISTORICA FIIH
-G;;$ 9#anE es%#i?e !'s %'n%e(t's ?0si%'s (a#a %a!%+!a# e! VS
ese e! %'nt#'n' e !a 'na e (+!s' a#te#ia!
-;G>$ Lesse!in7 esa##'!!a +n a!7'#it&' ?asa' en e! an0!isis
e! %'nt'#n' e (+!s' a#te#ia! (a#a &'nit'#i5a# e! KC
%'ntin+a&ente
-;;;$ K'e7e 4a!ia e! KCCP %'n KCAP / KCA in%!+s' en
(#esen%ia e 4a#ia%i'nes ,e&'in0&i%as / e! t'n' 4as%+!a#
Cent#a! 4en'+s %at,ete#
Inje%tate te&(e#at+#e
sens'# ,'+sin7
PV404@
A#te#ia! t,e#&'i!+ti'n %at,ete#
Inje%tate te&(e#at+#e sens'# %a?!e
PCG0-0;
PULSION is('sa?!e (#ess+#e t#ans+%e# PVG--=
PCCI
AP
13.03 16.28 TB37.0
AP 140
117 92
(CVP) 5
SVRI 2762
PC
CI 3.24
HR 78
SVI 42
SVV 5%
dPmx 1140
(GEDI) 625
DPT M'nit'#
%a?!e
PMM-C0@
Inte#6a%e %a?!e
PCG0-=0
C'nne%ti'n %a?!e
t' ?esie &'nit'#
PMM - NNN
AUN aa(te#
%a?!e
PCG-C00
Pi%%' plus set+(
M"t'' e Te#&'i!+%i)n T#ans(+!&'na#
Cat"te# TD A#te#ia!
FeB7B PVC0-=LC0H
VC In/e%%i)n en :'!'
RAEDV
P:V
ETV
LAEDV
LVEDV
ETV
RVEDV
0 -0 C0 >0 40 =0
030
03C
034
03@
OPCQ
T
Inje%ti'n
OsQ
Ran7's N'#&a!es
Parmetro Rango Unidad
CI >B0 R =B0 !S&inS&C
SVI 40 R @0 &!S&C
SVRI -C00 R -G00 /nTsT%&-=T&
MAP <0 R ;0 &&H7
KE9 C= R >= U
C9I 4B= R @B= -S&in
HR @0 R ;0 -S&in
KEDVI @G0 R G00 &!S&C
IT:VI G=0 R -000 &!S&C
SVV -0 U
EVLLI >B0 R <B0 &!SE7
PVPI -B0 R >B0
An0!isis e! %'nt'#n' e! (+!s'
a#te#ia!
t OsQ
P O&& H7Q
Ran7's N'#&a!es
SVI 40 R @0 &!S&C
MAP <0 R ;0 &&H7
KE9 C= R >= U
C9I 4B= R @B= -S&in
HR @0 R ;0 -S&in
IT:VI G=0 R -000 &!S&C
SVV -0 U
PVPI -B0 R >B0
INDICACION
Ne%esia e &'nit'#i5a# e! esta' %a#i'4as%+!a# /
%i#%+!at'#i' e %+a!J+ie# (a%iente3 tant'
int#a'(e#at'#ia&ente %'&' en !a #eani&a%i)n3
sie&(#e / %+an' !a #e!a%i)n ?ene6i%i' S #ies7' sea
6a4'#a?!e
CONTRAINDICACIONES
Pa%ientes en !'s J+e !a %'!'%a%i)n e +n %at"te#
a#te#ia! est" %'nt#aini%aa
Pa%ientes %'n AA:P
TERMODILUCION VOLUMETRICA INTERMITENTE
- Determinacin del GC por termodilucin transpulmonar
- Principios del clculo de volmenes
- ITBV y GEDV Volumen san!u"neo intratorcico y volumen
d"astlico #inal !lo$al
Estimacin de ITBV usando el m%todo de TD simple
Volumen diastlico #inal !lo$al GEDV
&i!ni#icado #isiol!ico de GEDV
&i!ni#icado #isiol!ico de ITBV
ITBV como !u"a en el mane'o (emodinmico
- Indice de #uncin cardiaca C)I
- *!ua pulmonar e+travascular EV,-
Estimacin de EV,- .mediante el ITBV estimado/
&i!ni#icado #isiol!ico de EV,-
EV,- como indicador de modos espec"#icos de ventilacin
- Indice de permea$ilidad vascular pulmonar PVPI
T? inje%ti'n
t
Dete#&ina%i)n e! 7ast' %a#ia%' ('# TD
t#ans(+!&'na#
SteIa#t-Ha&i!t'n
&et,'
T? V :!'' te&(e#at+#e
Ti V Inje%tate te&(e#at+#e
Vi V Inje%tate 4'!+&e
W X T? B t V A#ea +ne# t,e t,e#&'i!+ti'n %+#4e
M V C'##e%ti'n %'nstant3 &ae +( '6 s(e%i6i% Iei7,t
an
s(e%i6i% ,eat '6 ?!'' an inje%tate
C'&(a#a%i)n e COTDa / COTD(a
Author n (patients / measurements) COTDa - COTDpa r
bias SD
4'n S(ie7e! et a!3 -;;@ C- S 4G - 4B< -B=U 0B;<
*naest(esist 01 .22/
M% L+%Eie et a!3 -;;@ ; S Y 0B-; 0BC- !S&inS&C
*cta Paediatr 31
K'eje et a!3 -;;G >0 S -=0 Ft#i(!eH 0B-@ 0B>- !S&inS&C 0B;@
C(est 224 .0/
K'eje et a!3 -;;G >0 S G-0 0BC@ 0B< !S&in 0B;@
T(orac Cardiovasc &ur! 05
ZZ!!ne# et a!3 -;;G -G S -@0 F->- '+?!e S C; t#i(!eH 0B0> -B04 !S&in 0B;-
*naest(esist 06 .22/
K'eje et a!3 -;;; C4 S C-@ Ft#i(!eH -0BC; 0B@@ !S&in 0B;>
Crit Care 7ed 86 .22/
SaEEa et a!3 -;;; >< S 44; 0B@G 0B@C !S&in 0B;<
Intensive Care 7ed 81
SaEEa et a!3 C000 -C S =- Ft#i(!eH 0B<> 0B>G !S&in 0B;G
9 Cardiot(orac Vasc *nest( 20 .8/
:ine!s et a!3 C000 4= S CG> 0B4; 0B4= !S&inS&C 0B;=
Crit Care 0
H'!& et a!3 C00- C> S C-G 0B>C 0BC; !S&in 0B;G
Burns 86
P#in%i(i's e! %0!%+!' e 4'![&enes
!n % FIH
inje%ti'n
At
#e%i#%+!ati'n
MTt
t
e
--
DSt
% FIH
MTt$ Mean t#ansit ti&e
\ ,a!6 '6 t,e ini%at'# (asse
t,e ('int '6 ete%ti'n
DSt$ D'Ins!'(e ti&e
\ e8('nentia! 'Ins!'(e ti&e '6 TD %+#4e
P#in%i(i's e! %0!%+!' e 4'![&enes FIIH
Va!! V V- ] VC ] V> ] V4 V MTt 8 9!'I
V> V !a#7est 4'!+&e V DSt 8 9!'I
T,e MTt ete#&ines t,e I,'!e 4'!+&e
t,e ini%at'# (asse t,#'+7, 6#'& t,e
('int '6 inje%ti'n t' t,e ('int '6
ete%ti'nB
T,e DSt ete#&ines t,e !a#7est
sin7!e 4'!+&e F&inB C0U !a#7e#^H in a
se#ies '6 &i8in7 %,a&?e#s
6!'I
V>
V4
VC
V-
inje%ti'n
ete%ti'n
- Principios del clculo de volumen
diastlico #inal !lo$al
Esti&a%i)n e IT:V +san' e! &"t'' e TD si&(!e
V'![&en san7+.ne' int#at'#0%i%' FIT:VH
RAEDV
P:V
LAEDV
LVEDV
RVEDV
Re!a%i)n ent#e IT:VTD / KEDVST
Saa et al! "ntensi#e Care $ed %&' ()*-()+! %***
KEDV 4sB IT:V in =< intensi4e %a#e
(atients
IT:V V -BC= T KEDV R CGB4
O&!Q
# V 0B;@
IT:VTD F&!H
KEDVST F&!H
Te#&'i!+%i)n IT:VIST 4sB t,e#&'-/e i!+%i)n IT:VITD
n V C0;
# V 0B;<
:ias V -<B@ &!S&C
SD V =<B4 &!S&C
IT:VIST 4sB IT:VITD in C0; intensi4e %a#e
(atients
V'!+&en iast)!i%' 6ina! 7!'?a!$ KEDV
- Indice de perme$ilidad vascular pulmonar PVPI
KEDV V K!'?a! en-iast'!i% 4'!+&e
En-iast'!i% 4'!+&e '6 t,e 4 ,ea#t %,a&?e#s
PTV
RAEDV
LAEDV
LVEDV
RVEDV
KEDV
KEDV V ITTV - PTV
P#in%i(i's e! %0!%+!' e 4'![&enes FIIIH
P#in%i(i's e! %0!%+!' e 4'![&enes FIVH
RAEDV
LAEDV
LVEDV
RVEDV
PTV
ITTV
PTV V P+!&'na#/ T,e#&a! V'!+&e
!a#7est t,e#&a! 4'!+&e in t,e se#ies '6 &i8in7 %,a&?e#s FDSt R V'!+&eH
ITTV V Int#at,'#a%i% T,e#&a! V'!+&e
4'!+&e 6#'& t,e ('int '6 inje%ti'n t' t,e ('int '6 ete%ti'n FMTt R V'!+&eH
ITTV V CO T
MTtTDa
PTV V CO T
DStTDa
IT:V V -BC= T
KEDV
EVLL V ITTV -
IT:V
KEDV V ITTV -
PTV
RAEDV RVEDV LAEDV LVEDV
RAEDV RVEDV LAEDV LVEDV P:V
RAEDV RVEDV LAEDV LVEDV PTV
PTV
EVLL
EVLL
Ca!%+!ati'n '6 4'!+&es
Si7ni6i%a' 6isi'!)7i%' e KEDV
Si7ni6i%a' 6isi'!)7i%' e IT:V
KEDV V K!'?a! en-iast'!i% 4'!+&e
En-iast'!i% 4'!+&e '6 t,e 4 ,ea#t %,a&?e#s
PTV
RAEDV
LAEDV
LVEDV
RVEDV
KEDV
KEDV V ITTV - PTV
IT:V %'&' 7+.a en e! &anej' ,e&'in0&i%'
,oed-e et al! .ur / Cardiothora0 Surg (1 (2)' 211-2134dis0ussion 213-25*! (33)
C'##e!a%i)n e !'s ini%a'#es e (#e%a#7a %'n SVI / CI FH
P#esi'nes %'&' ini%a'#es e (#e%a#7a
6i0ht7ar0-As0ho88 et al! "ntensi#e Care $ed ()' (5%-(5+! (33%
6i0ht7ar0-As0ho88 et al! "ntensi#e Care $ed ()' (5%-(5+! (33%
IT:V %'&' ini%a'# e (#e%a#7a
- Ini%e e 6+n%i)n %a#ia%a$ C9I
A7+a P+!&'na# E8t#a4as%+!a#
EVLL
EVLL
C!ini%a! 4a!iati'n
0 C00 400 @00 G00 -000 -C00
CB=
=B0
<B=
-0B0
KEDVI F&!S&CH
CI F!S&inS&CH
V'!+&e
In't#'(i%s
n'#&a!
#an7e
n'#&a! %a#ia%
6+n%ti'n
C9I V CI S KEDVI
Ini%e e 6+n%i)n %a#ia%a
- A7+a (+!&'na# e8t#a4as%+!a#$ EVLL
Esti&a%i)n e EVLL F&eiante e! IT:V esti&a'H
ITTV V CO T
MTtTDa
PTV V CO T
DStTDa
IT:V V -BC= T
KEDV
EVLL V ITTV -
IT:V
KEDV V ITTV -
PTV
RAEDV RVEDV LAEDV LVEDV
RAEDV RVEDV LAEDV LVEDV P:V
RAEDV RVEDV LAEDV LVEDV PTV
PTV
EVLL
EVLL
Ca!%+!ati'n '6 4'!+&es
Te#&'i!+%i)n EVLLIST 4sB t,e#&'-/e i!+%i)n EVLLITD
:ias V -0BC &!SE7
SD V -B4 &!SE7
n V C0;
# V 0B;@
EVLLIST 4sB EVLLITD in C0; intensi4e %a#e
(atients
Sturm! "n' Pra0ti0al Appli0ations o8 9iberopti0s in Criti0al Care
$onitoring!
Springer :erlag ;erlin - <eidelberg - =e7>or (33*! pp (%3-(13
Va!ia%i)n e EVLL FIH
EVLL ?/ ini%at'# i!+ti'n %'&(a#e t' 7#a4i&et#i% EVLL
&eas+#e&ent in ?#ain-ea ,+&ans
Mat5ene!s'n et a!3 SCCM C00C3 A?st#a%t
PiCCO R EVLL 4s K#a4i&et#i% EVLL in '7s3
%a#i'7eni% ] n'n%a#i'7eni% PE
Va!ia%i)n e EVLL FIIH
Si7ni6i%a' 6isi'!)7i%' e EVLL
;?0! 6e7is! "n' Pra0ti0al Appli0ations o8 9iberopti0s in Criti0al Care
$onitoring!
EVLL / O8i7ena%i)n
S'+#%e C'&(a#is'n C'##e!ati'n
:a+eniste! et a!3 -;GC N-#a/ s%'#e 4sBEVLL << U
9 Trauma 88 :34
Si??a! et a!3 -;G> %'&(a#is'n %a#ia% ee&a # V 03@@
C(est 34 681 %'&(a#is'n n'n %a#ia% ee&a # V 03<
Si4aE et a!3 -;G> N-#a/ s%'#e 4s EVLL @4 U
Crit Care 7ed; 22 0:3 N-#a/ s%'#e 4sB EVLL 4C U
La77ne# et a!3 -;G4 N-#a/ s%'#e 4sB EVLL # V 03G4
Intensive Care 7ed; 2< 4<:
Ha!(e#in et a!3 -;G= N-#a/ s%'#e 4sB # V 03=-
C(est 33 50: EVLL
Ha!!e# et a!3 -;G= N-#a/ s%'#e 4sB EVLL @@ U
)ortsc(r; =>nt!enstr; 208 53
Eisen?e#7 et a!3 -;G< N-#a/ s%'#e 4sB EVLL <@ U
*m =ev =esp Dis 245 558
TaEea et a!3 -;;= N-#a/ s%'#e 4sB EVLL N-#a/ insensiti4e
9 Vet 7ed &ci 16 .4/ 032
C'&(a#a%i)n e EVLL %'n !a R8 e
t'#a8
EVLL %'&' ini%a'# e &''s es(e%.6i%'s e 4enti!a%i)n
Re!e4an%ia e! &anej' %'n EVLL
A8ter' $it0hell et al! Am Re# Resp Dis (52' 33*-33)!
(33%
CC a/s
-= a/s
; a/s
< a/s
RHC 7#'+( RHC 7#'+( EVLL 7#'+( EVLL 7#'+(
Venti!ati'n a/s ICU a/s

nV-0-
Sturm! "n' Pra0ti0al Appli0ations o8 9iberopti0s in Criti0al Care
$onitoring!
EVLL / &'#ta!ia
- Ini%e e (e#&ea?i!ia 4as%+!a# (+!&'na#$ PVPI
N+e4's (a#0&et#'s
KE9 V
KEDV
4 8 SV
K!'?a! eje%ti'n 6#a%ti'n
PVPI V
P:V
EVLL
Esti&ati'n '6 (+!&'na#/ 4as%+!a#
(e#&ea?i!it/
Re!a%i)n ent#e ITV:I / EVLLI IT:VI
t' EVLLI
PVPI in%#ease
PVPI n'#&a!
An0!isis e! %'nt'#n' e! (+!s'
a#te#ia!
t OsQ
P O&& H7Q
ANALISIS DEL CONTORNO DEL PULSO ARTERIAL
P#in%i(i's e !a &ei%i)n
Pa#0&et#'s '?teni's ('# an0!isis e! %'nt'#n' e (+!s'
PCCO$ Kast' %a#ia%' ('# %'nt'#n' e (+!s'
SVV$ Va#ia%i)n e! 4'![&en sist)!i%'
PPV$ Va#ia%i)n e !a (#esi)n e! (+!s'
PSt&a8$ .ni%e e %'nt#a%ti!ia e! 4ent#.%+!' i5J+ie#'
PFtH
PFtH
S.st'!e Di0st'!e
C'&(!ian%e A)#ti%a
Rise '6 t,e ?!'' (#ess+#e %+#4e e(enent 'n
t,e %,a#a%te#isti% C'&(!ian%e '6 t,e A'#ta
9a!! '6 t,e ?!'' (#ess+#e %+#4e e(enent 'n
t,e %,a#a%te#isti% C'&(!ian%e '6 t,e A'#ta
Ini4i+a! a'#ti% %'&(!ian%e CF(H
Meas+#e ?!'' (#ess+#e
FPFtH3 MAP3 CVPH
Re6e#en%e CO 4a!+e 6#'&
t,e#&'i!+ti'n
Dete#&ina%i)n e !a C'&(!ian%e a)#ti%a ini4i+a!
CF(H
A#ea +ne#
(#ess+#e
%+#4e
S,a(e '6
(#ess+#e
%+#4e
PCCO V %a! _ HR
_

S/st'!e
PFtH
SVR
] CF(H _
P
t
F H t
A'#ti%
%'&(!ian%e
Hea#t
#ate
Patient-s(e%i6i%
%a!i?#ati'n 6a%t'#
Fete#&ine ?/
t,e#&'i!+ti'nH
t OsQ
P O&& H7Q
C0!%+!' e PCCO M'e!'
PCCO is is(!a/e as !ast -Cs
&ean
Ran7's N'#&a!es
SVI 40 R @0 &!S&C
MAP <0 R ;0 &&H7
KE9 C= R >= U
C9I 4B= R @B= -S&in
HR @0 R ;0 -S&in
IT:VI G=0 R -000 &!S&C
SVV -0 U
PVPI -B0 R >B0
C'&(a#a%i)n ent#e PCCO / COTD(a
Author n (patients / measurements) PCCO - COTDpa r
bias SD
K'eje et a!3 -;;G >0 S C<0 Ft#i(!eH 0B-- 0B@ !S&in 0B;-
T(orac Cardiovasc &ur! 05
K'eje et a!3 -;;; C4 S C-@ Ft#i(!eH 0B0< 0B< !S&inS&C 0B;C
Crit Care 7ed 86 .22/
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