A pilot study of pulse contour cardiac output monitoring in patients with septic shock.
OBJECTIVE
To assess the relationship between PiCCO-derived signals and conventional measures of pre-load and gas exchange in patients with septic shock.


METHODS
Prospective observational study of 23 patients with septic shock. Scheduled collection of clinical, conventional haemodynamic and PiCCO derived variables. Statistical analysis of correlations.


RESULTS
Patients had a mean SAPS II score of 53.5 +/- 14.5 with 78.3% on mechanical ventilation at PiCCO insertion. PiCCO monitoring lasted a mean of 4.3 +/- 2.9 days. SAPS II predicted 28-day mortality was 54.2%, while actual mortality was 39.1%. At PiCCO insertion, there was an inverse correlation between cardiac (CI) and extravascular lung water index (EVLWI) (r = -0.442; p < 0.05). During treatment, the most significant correlation was between the PiCCO-derived global end-diastolic volume index (GEDVI) and PaO(2)/F(I)O(2) ratio (r = 0.386; p < 0.01). There was also a correlation between changes in GEDVI and changes in CI (r = 0.329; p < 0.01). Increases in EVLWI correlated with decreases in PaO(2)/F(I)O(2) ratio( )(r = -0.332; p < 0.01).


CONCLUSIONS
PiCCO-derived pre-load and extravascular lung water signals show logical associations with conventional indirect indicators of haemodynamic and fluid status suggesting physiological and clinical relevance.
Department of Intensive Care, University of Melbourne, Austin Hospital, Heidelberg, VIC 3084, Australia.
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L
Wan
T
T
Naka
S
S
Uchino
R
R
Bellomo