title: Pulse contour cardiac output monitoring in acute heart failure patients : Assessment of hemodynamic measurements.
abstract: BACKGROUND
  Heart failure is known to be a major public health problem. Fluid redistribution contributes to acute heart failure; therefore, knowledge of hemodynamic parameters could be important for optimizing outcomes. The pulse contour cardiac output monitor PiCCO uses the single thermal indicator technique and pulse contour analysis to calculate hemodynamic parameters of preload, afterload, cardiac output, systemic vascular resistance and extravascular lung water.
  
  
  OBJECTIVE
  We primarily aimed to describe values and parameters seen in acute heart failure patients admitted to the intensive care unit (ICU) and secondly to investigate associations between hemodynamic measurements and survival data.
  
  
  METHODS
  In this study 420 consecutive patients admitted to a tertiary medical university hospital ICU between January 2004 and December 2009 were retrospectively investigated. The study sample was divided into two subgroups: patients monitored by PiCCO (n = 47) and those not monitored by thermodilution measurements (n = 373). No predetermined treatment algorithm based on knowledge obtained by the PiCCO monitor was used and measurements were individually interpreted by the treating physician. The PiCCO monitor measurements were carried out according to manufacturer's directions.
  
  
  RESULTS
  Patients with PiCCO monitoring were clinically in poorer health with a mean simplified acute physiology score II (SAPS2) of 45 ± 17 vs. 56 ± 20 (p < 0.01). The ICU mortality (22 % vs. 38 %, p = 0.02) and, at least as a tendency, long-term-mortality were increased in patients monitored by PiCCO (RR 1.49, 95 % CI 0.96-2.31, p = 0.08). We provide hemodynamic measurements in acute heart failure patients: cardiac index (2.7 ± 1.2 l/min/m²) was reduced, preload and extravascular lung water index (EVLWI, 11.5 ± 5.1 ml/kg body weight), representing lung edema, were increased.
  
  
  CONCLUSIONS
  We provide real world values for PiCCO parameters in acutely decompensated heart failure. In our study patients who were clinically in poorer health were monitored with PiCCO, resulting in increased mortality in this group. Further prospective studies to investigate the effects of treatment decisions triggered by information obtained by PiCCO monitoring for patients in acute heart failure are needed.
authors.affiliation: University Clinic of Internal Medicine II, Paracelsus Medical University, Salzburg, Austria.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Wernly
authors.affiliation: University Clinic of Internal Medicine II, Paracelsus Medical University, Salzburg, Austria.
authors.forename: Michael
authors.initials: M
authors.lastname: Lichtenauer
authors.affiliation: Clinic of Internal Medicine I, Friedrich-Schiller-University, Jena, Germany.
authors.forename: Marcus
authors.initials: M
authors.lastname: Franz
authors.affiliation: Clinic of Internal Medicine I, Friedrich-Schiller-University, Jena, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Fritzenwanger
authors.affiliation: Clinic of Internal Medicine I, Friedrich-Schiller-University, Jena, Germany.
authors.forename: Bjoern
authors.initials: B
authors.lastname: Kabisch
authors.affiliation: Clinic of Internal Medicine I, Friedrich-Schiller-University, Jena, Germany.
authors.forename: Hans-Reiner
authors.initials: HR
authors.lastname: Figulla
authors.affiliation: Clinic of Cardiology, Pneumology and Angiology, University Clinic Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany. Christian.Jung@med.uni-duesseldorf.de.
authors.forename: Christian
authors.initials: C
authors.lastname: Jung
mesh_terms: D000368:Aged; D001795:Blood Pressure Determination / Q000379:methods; D002302:Cardiac Output; D003936:Diagnosis, Computer-Assisted / Q000379:methods; D015633:Extravascular Lung Water; D005260:Female; D006333:Heart Failure / Q000175:diagnosis* / Q000503:physiopathology*; D006801:Humans; D008297:Male; D015203:Reproducibility of Results; D012129:Respiratory Function Tests / Q000379:methods*; D012680:Sensitivity and Specificity; D013815:Thermodilution / Q000379:methods*; D014655:Vascular Resistance
keywords: Cardiac index; Critically ill; Heart failure; Intensive care; PiCCO