Clinical significance of pulse contour cardiac output monitoring technology in guiding fluid replacement during shock stage of extensive burn / 中华烧伤杂志

Objective@#To explore the guiding significance of pulse contour cardiac output (PiCCO) monitoring technology in the treatment of fluid replacement during shock stage of extensive burn in clinic.@*Methods@#Sixty-five patients with extensive burn hospitalized in our unit from January 2014 to December 2018, conforming to the inclusion criteria, were recruited to conduct a prospective controlled research. According to the order of admission, 35 odd-numbered patients and 30 even-numbered patients were enrolled in routine rehydration group (25 males and 10 females) and PiCCO monitoring rehydration group (21 males and 9 females) respectively, with the age of (48±9) and (44±8) years respectively. All patients of the two groups were rehydrated according to the rehydration formula of the Third Military Medical University during shock stage. The rehydration speed was adjusted in routine rehydration group according to the general indexes of shock such as central venous pressure, mean arterial pressure, heart rate, respiratory rate, urine volume, and clinical symptoms of patients. PiCCO monitoring was performed in patients of PiCCO monitoring rehydration group, and the global end-diastolic volume index combined with the other relevant indicators of PiCCO were used to guide rehydration on the basis of the monitoring indicators of routine rehydration group. The heart rates and positive fluid balance volumes at post injury hour (PIH) 8, 16, 24, 32, 40, 48, 56, 64, and 72, the diuretic dosage at PIH 48 and 72, the total fluid replacement volumes, urine volumes, blood lactic acid, platelet count, and hematocrit at PIH 24, 48, and 72, the length of intensive care unit (ICU) stay, and the incidence of complications and death within 28 days after injury were compared between patients in the two groups. Data were processed with analysis of variance for repeated measurement, t test, Bonferroni correction, Mann-Whitney U test, chi-square test, and Fisher′s exact probability test.@*Results@#The heart rates of patients in the two groups were similar at PIH 8, 16, 24, 32, 40, 48, and 56 (t=0.775, 1.388, 2.511, 2.203, 1.654, 2.303, 1.808, P>0.05), and the heart rates of patients in PiCCO monitoring rehydration group at PIH 64 and 72 were obviously lower than those of routine rehydration group (t=3.229, 3.357, P<0.05 or P<0.01). The positive fluid balance volumes of patients in the two groups were similar at PIH 8, 16, 40, and 56 (t=0.768, 1.670, 2.134, 2.791, P>0.05), and the positive fluid balance volumes of patients in PiCCO monitoring rehydration group at PIH 24, 32, 48, 64, and 72 were obviously less than those of routine rehydration group (t=3.364, 4.047, 2.930, 2.950, 2.976, P<0.05 or P<0.01). The amount of diuretics used by patients in the two groups was similar at PIH 48 and 72 (Z=-0.697, -1.239, P>0.05). The total fluid replacement volumes of patients in PiCCO monitoring rehydration group at PIH 24, 48, and 72 were (13 864±4 241), (9 532±2 272), and (8 480±2 180) mL, respectively, obviously more than those in routine rehydration group [(10 388±2 445), (8 095±1 720), and (7 059±1 297) mL, respectively, t=-3.970, -2.848, -3.137, P<0.05 or P<0.01]. The urine volumes of patients in the two groups at PIH 24 were close (t=-1.027, P>0.05). The urine volumes of patients in PiCCO monitoring rehydration group at PIH 48 and 72 were (3 051±702) and (3 202±624) mL respectively, obviously more than those in routine rehydration group [(2 401±588) and (2 582±624) mL respectively, t=-4.062, -4.001, P<0.01]. The levels of blood lactate acid of patients in PiCCO monitoring rehydration group at PIH 24, 48, and 72 were obviously lower than those in routine rehydration group (t=4.758, 6.101, 3.938, P<0.01). At PIH 24 and 48, the values of the platelet count of patients in PiCCO monitoring rehydration group were obviously higher than those in routine rehydration group (t=-2.853, -2.499, P<0.05), and the values of hematocrit of patients in PiCCO monitoring rehydration group were obviously lower than those in routine rehydration group (t=2.698, 4.167, P<0.05 or P<0.01). Both the platelet count and hematocrit of patients in the two groups were similar at PIH 72 (t=-1.363, 0.476, P>0.05). The length of ICU stay of patients in PiCCO monitoring rehydration group was obviously shorter than that of routine rehydration group (t=2.184, P<0.05). Within 28 days after injury, the incidence of complications of patients in routine rehydration group was obviously higher than that in PiCCO monitoring rehydration group (P<0.05), while the mortality rate of patients in routine rehydration group was similar to that in PiCCO monitoring rehydration group (P>0.05).@*Conclusions@#The application of PiCCO monitoring technology in monitoring fluid replacement in patients with extensive burn can quickly correct shock, reduce the occurrence of organ complications caused by improper fluid replacement, and shorten the length of ICU stay, which is of great significance in guiding the treatment of burn shock.

Effects of pulse contour cardiac output monitoring technology in amelioration of myocardial damage in fluid resuscitation of patients with large area burn in the early stage / 中华烧伤杂志

Objective@#To analyze effects of pulse contour cardiac output (PiCCO) monitoring technology in amelioration of myocardial damage in fluid resuscitation of patients with large area burn in the early stage.@*Methods@#From November 2015 to November 2017, medical data of 52 patients with large area burn hospitalized in our unit, meeting the inclusion criteria, were analyzed retrospectively. Twenty-seven patients (18 males and 9 females) with age of (43±10)years in tradition group hospitalized from November 2015 to November 2016 were monitored by traditional monitoring methods for fluid resuscitation, and 25 patients (18 males and 7 females) with age of (44±10)years in PiCCO group hospitalized from December 2016 to November 2017 were monitored by traditional monitoring methods and PiCCO monitoring equipment for fluid resuscitation. Fluid infusion coefficients and total fluid replacement volume of patients in both groups at the first and second post burn hour (PBH) 24, as well as the levels of N terminal pro B type natriuretic peptide (NT-proBNP), cardiac troponin T (cTnT), and creatine kinase MB (CK-MB) immediately on admission and post burn day (PBD) 1, 2, 3, 4, 5, 6, and 7 were recorded. Data were processed with analysis of variance for repeated measurement, chi-square test, t test and Bonferroni correction, and Mann-Whitney U test and Bonferroni correction.@*Results@#(1) The fluid infusion coefficients of patients in tradition group at the first and second PBH 24 were respectively (1.42±0.10) and (0.94±0.14)mL·kg-1·% total body surface area (TBSA)-1, and those in PiCCO group were respectively (1.76±0.14) and (0.85±0.08) mL·kg-1·%TBSA-1. Fluid infusion coefficient and total fluid replacement volume at the first PBH 24 of patients in PiCCO group were significantly higher than those in tradition group (t=-9.775, -4.769, P<0.01). Fluid infusion coefficient at the second PBH 24 of patients in PiCCO group was significantly lower than that in tradition group (t=2.682, P<0.05). There was no statistically significant difference in total fluid replacement volume at the second PBH 24 in patients between the two groups (t=1.167, P>0.05). (2) Immediately on admission and PBD 1, 2, 3, 4, 5, 6, and 7, the levels of NT-proBNP of patients in tradition group were respectively 518 (320, 763), 236 (98, 250), 139 (62, 231), 172 (104, 185), 296 (225, 341), 727 (642, 921), 1 840 (1 357, 2 081), 1 005 (671, 1 297) pg/mL, and those in PiCCO group were respectively 444 (206, 601), 66 (29, 73), 54(28, 75), 139(101, 175), 199 (106, 279), 576 (333, 837), 833 (466, 1 080), 485 (225, 710) pg/mL. The levels of NT-proBNP of patients in PiCCO group on PBD 1, 2, 6, and 7 were significantly lower than those in tradition group (Z=-5.004, -3.967, -5.285, -4.626, P<0.01). The levels of NT-proBNP immediately on admission and PBD 3, 4, and 5 in patients between the two groups were close (Z=-0.834, -0.806, -2.665, -2.153, P>0.05). (3) Immediately on admission and PBD 1, 2, 3, 4, 5, 6, and 7, the levels of cTnT of patients in tradition group were respectively (42±15), (21±12), (17±7), (11±4), (12±4), (94±32), (88±23), (42±23) pg/L, and those in PiCCO group were respectively (37±15), (9±3), (10±3), (13±3), (12±5), (85±30), (60±26), (22±14) pg/L. The levels of cTnT of patients in PiCCO group on PBD 1, 2, 6, and 7 were significantly lower than those in tradition group (t=5.227, 4.751, 4.239, 3.845, P<0.01). The levels of cTnT immediately on admission and PBD 3, 4, and 5 of patients between the two groups were close (t=1.098, -1.562, -0.117, 1.107, P>0.05). (4) The levels of CK-MB of patients in PiCCO group on PBD 3, 6, and 7 were significantly lower than those in tradition group (t=3.123, 4.103, 3.178, P<0.05 or P<0.01). The levels of CK-MB immediately on admission and PBD 1, 2, 4, and 5 in patients between the two groups were close (t=0.351, 1.868, 1.100, 0.798, 2.094, P>0.05).@*Conclusions@#PiCCO monitoring technology can monitor and guide fluid resuscitation of patients with large area burn in the early stage more scientifically and reasonably, and the effect of reducing myocardial damage is better than traditional monitoring methods.

Effects of application of pulse contour cardiac output monitoring technology in early treatment of patients with large area burns / 中华烧伤杂志

Objective@#To analyze the changes and relationship of early hemodynamic indexes of patients with large area burns monitored by pulse contour cardiac output (PiCCO) monitoring technology, so as to assess the guiding value of this technology in the treatment of patients with large area burns during shock period.@*Methods@#Eighteen patients with large area burns, confirming to the study criteria, were admitted to our unit from May 2016 to May 2017. Pulse contour cardiac output index (PCCI), systemic vascular resistance index (SVRI), global end-diastolic volume index (GEDVI), and extravascular lung water index (EVLWI) of patients were monitored by PiCCO instrument from admission to post injury day (PID) 7, and they were calibrated and recorded once every four hours. The fluid infusion coefficients of patients at the first and second 24 hours post injury were calculated. The blood lactic acid values of patients from PID 1 to 7 were also recorded. The correlations among PCCI, SVRI, and GEDVI as well as the correlation between SVRI and blood lactic acid of these 18 patients were analyzed. Prognosis of patients were recorded. Data were processed with one-way analysis of variance, single sample ttest and Bonferroni correction, Pearson correlation analysis, and Spearman rank correlation analysis.@*Results@#(1) There was statistically significant difference in PCCI value of patients from post injury hour (PIH) 4 to 168 (F=7.428, P<0.01). The PCCI values of patients at PIH 4, 8, 12, 16, 20, and 24 were (2.4±0.9), (2.6±1.2), (2.2±0.6), (2.6±0.7), (2.8±0.6), and (2.7±0.7) L·min-1·m-2, respectively, and they were significantly lower than the normal value 4 L·min-1·m-2(t=-3.143, -3.251, -11.511, -8.889, -6.735, -6.976, P<0.05 or P<0.01). At PIH 76, 80, 84, 88, 92, and 96, the PCCI values of patients were (4.9±1.5), (5.7±2.0), (5.9±1.7), (5.5±1.3), (5.3±1.1), and (4.9±1.4) L·min-1·m-2, respectively, and they were significantly higher than the normal value (t=2.277, 3.142, 4.050, 4.111, 4.128, 2.423, P<0.05 or P<0.01). The PCCI values of patients at other time points were close to normal value (P>0.05). (2) There was statistically significant difference in SVRI value of patients from PIH 4 to 168 (F=7.863, P<0.01). The SVRI values of patients at PIH 12, 16, 20, 24, and 28 were (2 298±747), (2 581±498), (2 705±780), (2 773±669), and (3 109±1 215) dyn·s·cm-5·m2, respectively, and they were significantly higher than the normal value 2 050 dyn·s·cm-5·m2(t=0.878, 3.370, 2.519, 3.747, 3.144, P<0.05 or P<0.01). At PIH 4, 8, 72, 76, 80, 84, 88, 92, and 96, the SVRI values of patients were (1 632±129), (2 012±896), (1 381±503), (1 180±378), (1 259±400), (1 376±483), (1 329±385), (1 410±370), and (1 346±346) dyn·s·cm-5·m2, respectively, and they were significantly lower than the normal value (t=-4.593, -0.112, -5.157, -8.905, -7.914, -5.226, -6.756, -6.233, -7.038, P<0.01). The SVRI values of patients at other time points were close to normal value (P>0.05). (3) There was no statistically significant difference in the GEDVI values of patients from PIH 4 to 168 (F=0.704, P>0.05). The GEDVI values of patients at PIH 8, 12, 16, 20, and 24 were significantly lower than normal value (t=-3.112, -3.554, -2.969, -2.450, -2.476, P<0.05). The GEDVI values of patients at other time points were close to normal value (P>0.05). (4) There was statistically significant difference in EVLWI value of patients from PIH 4 to 168 (F=1.859, P<0.01). The EVLWI values of patients at PIH 16, 20, 24, 28, 32, 36, and 40 were significantly higher than normal value (t=4.386, 3.335, 6.363, 4.391, 7.513, 5.392, 5.642, P<0.01). The EVLWI values of patients at other time points were close to normal value (P>0.05). (5) The fluid infusion coefficients of patients at the first and second 24 hours post injury were 1.90 and 1.39, respectively. The blood lactic acid values of patients from PID 1 to 7 were 7.99, 5.21, 4.57, 4.26, 2.54, 3.13, and 3.20 mmol/L, respectively, showing a declined tendency. (6) There was obvious negative correlation between PCCI and SVRI (r=-0.528, P<0.01). There was obvious positive correlation between GEDVI and PCCI (r=0.577, P<0.01). There was no obvious correlation between GEDVI and SVRI (r=0.081, P>0.05). There was obvious positive correlation between blood lactic acid and SVRI (r=0.878, P<0.01). (7) All patients were cured except the one who abandoned treatment.@*Conclusions@#PiCCO monitoring technology can monitor the changes of early hemodynamic indexes and volume of burn patients dynamically, continuously, and conveniently, and provide valuable reference for early-stage comprehensive treatment like anti-shock of patients with large area burns.

Advances in the research of application of pulse contour cardiac output monitor technology in patients with large area of burns / 中华烧伤杂志

Pulse contour cardiac output (PiCCO) monitor as an invasive monitoring technology has been widely applied to various kinds of critical patients. It can reliably reflect actual hemodynamics of critical patients and monitor parameters such as cardiac output. Fluid resuscitation is of great importance for patients with large area of burns. On account of its easy operation as well as precise and comprehensive parameters, PiCCO has been widely used in circulation monitoring of patients with large area of burns. This article briefly introduces PiCCO monitor technology and reviews its application in fluid resuscitation monitoring, diagnosis and identification of pneumonedema in patients with large area of burns, as well as the new theory and knowledge.

National experts consensus on application of pulse contour cardiac output monitoring technique in severe burn treatment (2018 version) / 中华烧伤杂志

As a newly developed technique for hemodynamic monitoring, pulse contour cardiac output (PiCCO) monitoring takes great advantages in guiding shock resuscitation and fluid administration. PiCCO has been used more and more in burn patients in recent years, however there is no clinic consensus on how to apply PiCCO monitoring, understand the significance of PiCCO monitored parameters, and guide the treatment using PiCCO monitored parameters in patients with severe burns. Based on the current literatures and the experts' clinical experience, (2018 ) is now issued by the Burn and Trauma Branch of Chinese Geriatrics Society, aiming to provide practical guidance for its usage in clinic.

National experts consensus on application of pulse contour cardiac output monitoring technique in severe burn treatment (2018 version) / 中华烧伤杂志

As a newly developed technique for hemodynamic monitoring, pulse contour cardiac output (PiCCO) monitoring takes great advantages in guiding shock resuscitation and fluid administration. PiCCO has been used more and more in burn patients in recent years, however there is no clinic consensus on how to apply PiCCO monitoring, understand the significance of PiCCO monitored parameters, and guide the treatment using PiCCO monitored parameters in patients with severe burns. Based on the current literature and the experts' clinical experience, (2018 ) is now issued by the Burn and Trauma Branch of Chinese Geriatrics Society, aiming to provide practical guidance for its usage in clinic.

Usefulness of the Endotoxin Activity Assay to Evaluate the Degree of Lung Injury

PURPOSE: It has been reported that the Pulse Contour Cardiac Output (PiCCO) is very useful mainly in the field of intensive care and treatment to grasp the pathophysiological conditions of pulmonary edema because of its capability of obtaining data such as Pulmonary Vascular Permeability Index (PVPI) and Extra Vascular Lung Water (EVLW). Furthermore, a high degree of usability of various markers has been reported for better understanding of the pathological conditions in cases with septicemia. MATERIALS AND METHODS: The correlation between the cardiorespiratory status based upon the PiCCO monitor (EVLW and PVPI) and inflammatory markers including C reactive protein, procalcitonin (PC), and Endotoxin Activity Assay (EAA) were evaluated in 11 severe cases that required treatment with a respirator in an intensive care unit. RESULTS: The EAA values were significantly higher in patients with abnormal EVLW at 0.46+/-0.20 compared to the normal EVLW group at 0.21+/-0.19 (p=0.0064). In a similar fashion, patients with abnormal PVPI values tended to have higher PC levels at 18.9+/-21.8 compared to normal PVPI cases at 2.4+/-2.2 (p=0.0676). On the other hand, PVPI was significantly higher in the abnormal EAA group at 3.55+/-0.48 in comparison with the normal EAA group at 1.99+/-0.68 (p=0.0029). The abnormal EAA group tended to have higher PVPI values than the normal EAA group. CONCLUSION: The EAA is a measurement method designed to estimate the activity of endotoxins in the whole blood. Our results suggest that the EAA value, which had the greatest correlation with lung disorders diagnosed by the PiCCO monitoring, reflects inflammatory reactions predominantly in the lungs.

Transpulmonary thermodilution for evaluating respiratory function in swine after severe acute dichlorvos poisoning / 中华急诊医学杂志

Objective In order to extrapolate the respiratory dysfunction of patients in early stage of acute organophosphorus pesticide poisoning (AOPP),transpulmonary thermodilution technique was used in swine models of severe acute dichlorvos poisoning (SADP) to evaluate respiratory function.Methods Twenty healthy female swine were randomly divided into dichlorvos ( n =7 ),atropine ( n =7 ) and control (n =6) groups.In the dichlorvos group,the swine were administered with 80％ emulsified dichlorvos (100mg/kg) via the gastric tube toinduce SADP.In the atropine group,swinewere administered with dichlorvos,and 0.5h later,atropine was injected to obtain and maintain atropinization.The swine of control group were administered with saline solution instead.Arterial and venous blood samples were collected 0,0.5,1,2,4 and 6 hours after modeling for blood gas analysis and detecting acetylcholinesterase levels.Both extravascular lung water index (EVLWI) and pulmonary vascular permeability index ( PVPI ) were measured by using PiCCO (pulse indicator continuous cardiac output ). At the termination of the experiment,the animals were sacrificed and the lung wet/dry weight ratio was determined and histopathological changes of lung tissue were also observed under microscope.Results In the dichlorvos group,EVLWI and PVPI were substantially increased from 0.5 h to 6 h after modeling but PaO2/FiO2 decreased from 0-6 h after modeling.In the atropine group,EVLWI and PVPI increased initially,but then they decreased 1 h afterwards and PaO2/FiO2 was also gradually decreased from 0-1 h.In both dichlorvos group and atropine group,the EVLWI was negatively correlated with PO2/FiO2 and positively correlated with PVPI.Compared with the control group,the lung wet/dry weight ratio increased markedly in the dichlorvos group and mildly increased in the atropine group.Meanwhile,the histopathological changes of lung tissue were obvious in the dichlorvos group and mild in the atropine group.Conclusions SADP swine experienced substantial changes in respiratory function. EVLWI was a reliable and valuable indicator for evaluating respiratory function in the early stage of AOPP.

Effectiveness of Human Atrial Natriuretic Peptide Supplementation in Pulmonary Edema Patients Using the Pulse Contour Cardiac Output System

PURPOSE: Atrial natriuretic peptide (ANP) has a variety of pharmacologic effects, including natriuresis, diuresis, vasodilatation, and suppression of the renin-angiotensin system. A recent study showed that ANP infusion improved hypoxemia and pulmonary hypertension in a lung injury model. On the other hand, the pulse contour cardiac output (PiCCO(TM)) system (Pulsion Medical Systems, Munich, Germany) allows monitoring of the intravascular volume status and may be used to guide volume therapy in severe sepsis and critically ill patients. MATERIALS AND METHODS: We treated 10 pulmonary edema patients without heart disease with human ANP (HANP). The patients were divided into two groups: a group with normal Intrathoracic Blood Volume (ITBV) (900-1100 mL/m2) (n = 6), and a group with abnormal ITBV (n = 4), as measured by the PiCCOtrade mark device; the extravascular lung water (EVLW) and pulmonary vascular permeability index (PVPI) in the two groups were compared. RESULTS: The average patient age was 63.9 +/- 14.4 years. The normal ITBV group showed significant improvement of the EVLW (before, 16.7 +/- 2.7 mL/kg; after, 10.5 +/- 3.6 mL/kg; p = 0.0020) and PVPI (before, 3.2 +/- 0.3; after, 2.1 +/- 0.7; p = 0.0214) after the treatment. The abnormal ITBV group showed no significant improvement of either the EVLW (before, 16.3 +/- 8.9 mL/kg; after, 18.8 +/- 9.6 mL/kg; p = 0.8387) or PVPI (before, 2.3 +/- 0.8; after, 2.7 +/- 1.3; p = 0.2782) after the treatment. In both groups, the EVLW and PVPI were strongly correlated with the chest X-ray findings. CONCLUSION: We conclude that HANP supplementation may improve the EVLW and PVPI in pulmonary edema patients without heart disease with a normal ITBV. The PiCCO(TM) system seems to be a useful device for the management of pulmonary edema.

A management of a pulmonary thromboembolism patient under monitoring of VigileoTM monitor (pulse contour cardiac output monitor) : A case report

Pulmonary embolism (PE) is an uncommon but, highly lethal condition that is a leading cause of death. However, prompt diagnosis and treatment can dramatically reduce the mortality rate and morbidity of PE. Unfortunately, the diagnosis is often missed because of vague and nonspecific symptoms. We report a case of pulmonary thromboembolism (PTE) which was developed during surgical preparation for pelvic bone and sacro-iliac joint reduction surgery after induction of general anesthesia. We monitored and treated efficiently the PTE patient under monitoring of VigileoTM monitor (pulse contour cardiac output monitor) in operating room and intensive care unit. After complete resolving of PTE, the surgery was reperformed with VigileoTM monitoring without any complications. We suggest that the VigileoTM monitor is simple and minimal invasive method to monitor the hemodynamic status in management of PTE patient.

Monitoring of transpulmonary thermodilution technique for quantification of extravascular lung water in dogs with ALI / 中华急诊医学杂志

Objective To evaluate the reliability of transpulmonary thermodilution technique,for the quantification of extravascular lung water.Method Eighteen dogs were randomly divided into 3 groups:normal group(n=6),ALIp(acute lung injury caused by pulmonary monary origin causes)group(n=6)and a ALIexp(acute lung injury caused by extra-pulmonary origin causes)(n=6).ALI_(exp)model was prepared by intravenous injection of injection of oleie acid.ALI_p model was made by inhalation of detergent.Extravascular lung water(EVLW)was measured by PiCCO monitor(PULSION,Germany)before and immediately after the intratracheal introduction of normal saline into the alveoh of lungs of normal and ALI dogs.Results The EVLW of the normal group was(254.5?13.0)mL.The volume of the normal between pre-and postinstillation(?EVLW) was approximate to the volume of normal saline instilled with a good correlation(r=0.986,P