[Minimally invasive cardiopulmonary monitoring with the PiCCO Plus system]

Insertion of a central venous catheter and an arterial catheter would be indicated in hemodynamically unstable or severely hypoxic patients in critical care units. In this setting, cardiorespiratory monitoring by transpulmonary thermodilution (TPTD) can be considered minimally invasive given that only a single arterial thermodilution catheter and a single central venous catheter are required to be connected to a specific monitor (the PiCCO Plus, Pulsion Medical Systems, Munich, Germany). TDTP simultaneously measures cardiac output, preloading, and cardiac function in hemodynamically unstable patients and predicts the response to volume. The technique can be managed by any health care professional. In hypoxic patients, TDTP identifies cases of pulmonary edema that might benefit from a negative fluid balance, evaluates pulmonary vascular permeability, facilitates our understanding of pathophysiologic mechanisms of hypoxemia, and predicts the likelihood of deleterious hemodynamic effects of positive end-expiratory pressures.