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[Preliminary clinical experience with PiCCO system in children with shock]
J Gil Antón1, C Cecchetti, S Menéndez
1UCIP, Hospital de Cruces, Vizcaya, España. javier.gilanton@osakidetza.net
Insights
The PiCCO monitor is safe and useful for assessing hemodynamics in pediatric shock patients. It provides valuable data on fluid status and response to treatment.
Area of Science:
- Pediatric critical care medicine
- Hemodynamic monitoring
- Cardiovascular physiology
Context:
- Pediatric shock is a life-threatening condition requiring precise hemodynamic assessment.
- Current monitoring methods may have limitations in accurately evaluating fluid responsiveness and cardiac function in children.
- The PiCCO (Picco) system offers continuous, minimally invasive hemodynamic monitoring.
Purpose:
- To evaluate the clinical utility and safety of the PiCCO (Picco) hemodynamics monitor in critically ill children experiencing shock.
- To assess the ability of PiCCO (Picco) derived parameters to reflect changes in preload and cardiac function in response to therapeutic interventions.
- To determine the feasibility of implementing PiCCO (Picco) monitoring in pediatric intensive care units (PICUs).
Summary:
- A prospective multicenter study involving 35 children (1 month to 18 years) with shock evaluated the PiCCO (Picco) system.
- Measurements were taken before and after interventions like fluid loading and vasoactive drug adjustments.
- PiCCO (Picco) monitoring proved feasible and safe, with significant correlations found between intrathoracic blood volume index (ITBI) and cardiac index (CI) changes post-fluid challenge.
Impact:
- PiCCO (Picco) derived parameters offer clinically relevant insights into preload status and its dynamic changes during treatment for pediatric shock.
- This monitoring technology can enhance therapeutic guidance and improve patient outcomes in pediatric critical care.
- The study supports the integration of PiCCO (Picco) monitoring into routine PICU practice for managing shock in children.
Purpose:
To evaluate the PiCCO hemodynamics monitor in terms of clinical usefulness in children with shock.
Methods:
Prospective multicenter analytical study in children aged from one month to 18 years with shock admitted to five pediatric intensive care units. Measurements were made before and after three interventions: a) volume load; b) increases in vasoactive drugs; c) dosage changes of drugs that could lessen vascular resistance. Recorded parameters included thermodilution data, along with the usual hemodynamic parameters.
Results:
A total of 120 measurements were performed on 35 patients: mean age 36 (2.6-156) months, mean weight 15 (5.8-72) kg. Shock etiology was septic in 37% of cases, cardiogenic in 26%, hypovolemic in 20% and neurogenic in 17%. No procedure related complication was noticed. Twenty-two volume challenges in 17 patients were registered. Volume load induced a significant intrathoracic blood volume index (ITBI) increase from 501(235-763) to 584 (418-810) ml/m(2), cardiac index (CI) 4.04 (2.58-6.25) to 4.48 (2.86-8.71) lmin-1m(2), and mean blood pressure from 74 (53-99) to 87 (59-112) mmHg. CI changes correlated with ITBI increase (r = 0.678, p = 0.001). 13 interventions to increase vasomotor tone were associated with an increase in contractility of 18% in systemic vascular resistance index (SVRI).
Conclusions:
Hemodynamic monitoring with the PiCCO system is feasible and seems safe in children with shock. PiCCO derived parameters could add clinically important information to assess preload state and its modifications with therapy.
