Monitoreo Hemodinámico con PiCCO2
Dr. Mateo Ferrero
Servicio de Cuidados Intensivos PediátricosServicio de Cuidados Intensivos Pediátricos
Un poco de historia............
A. 1929 Werner Forssman Aplicacion en humanos del principio de Fick
A.
Un poco de historia............
✔ Medición de GC mediante catéter de Swan Ganz
➔ Método gold standard últimas 4 décadas
Catéter de Swan Ganz
✔ Numeroso estudios indicaron que la CAP carece de
beneficios positivos en los resultados clínicos
➔ Binanay C, Califf RM, Hasselblad V, O’Connor CM, Shah MR, Sopko G,
StevensoLW, Francis GS, Leier CV, MillerLW, ESCAPE Investigators and ESCAPE Study
Coordinators.Evaluation study of congestive heart failure and pulmonary artery
catheterization effectiveness: the ESCAPE trial. JAMA. 2005;294(13):1625JAMA. 2005;294(13):1625––3333
➔ Schwann NM, Hillel Z, Hoeft A, Barash P, Möhnle P, Miao Y, Mangano DT. Lack of
effectiveness of the pulmonary artery catheter in cardiac surgery. Anesth Analg. Anesth Analg. effectiveness of the pulmonary artery catheter in cardiac surgery. Anesth Analg. Anesth Analg.
2011;113(5):9942011;113(5):994––10021002
➔ Harvey S, Harrison DA, Singer M, Ashcroft J, Jones CM, Elbourne D, Brampton
W, Williams D, Young D, Rowan K, PAC-Man study collaboration. Assessment of the
clinical effectiveness of pulmonary artery catheters in management of patients in intensive
care (PAC-Man): a randomised controlled trial. Lancet. 2005;366(9484):472Lancet. 2005;366(9484):472––7.7.
➔➔ Richard C, Warszawski J, Anguel N, Deye N, Combes A, Barnoud D, Boulain T, Richard C, Warszawski J, Anguel N, Deye N, Combes A, Barnoud D, Boulain T,
Lefort Y, Fartoukh M, Baud F, Boyer A, Brochard L, Teboul JL, French Pulmonary Artery Lefort Y, Fartoukh M, Baud F, Boyer A, Brochard L, Teboul JL, French Pulmonary Artery
Catheter Study Group. Early use of the pulmonary artery catheter and outcomes in patients Catheter Study Group. Early use of the pulmonary artery catheter and outcomes in patients
with shock and acute respiratory distress syndrome: a randomized controlled trial. with shock and acute respiratory distress syndrome: a randomized controlled trial. JAMA. JAMA.
2003;290:27132003;290:2713––20.20.
Catéter de Swan Ganz
✔ algunos estudios demostraron aumento en la mortalidad
hospitalaria
➔ Gore JM, Goldberg RJ, Spodick DH, Alpert JS, Dalen JE. A community-wide
assessment of the use of pulmonary artery catheters in patients with acute
myocardial infarction. Chest. 1987;92(4):721–7
➔ Connors AF Jr, Speroff T, Dawson NV, Thomas C, Harrell FE Jr, Wagner D,
Desbiens N, Goldman L, Wu AW, Califf RM, Fulkerson WJ Jr, Vidaillet H, Broste S,
Bellamy P, Lynn J, Knaus WA. The effectiveness of right heart catheterization in the
initial care of critically ill patients. SUPPORT investigator. JAMA.
1996;276(11):889–97.
➔ Zion MM, Balkin J, Rosenmann D, Goldbourt U, Reicher-Reiss H, Kaplinsky E,
Behar S. Use of pulmonary artery catheters in patients with acute myocardial
infarction. Chest. 1990;98:1331–5.
Catéter de Swan Ganz
✔ Estudios que muestran mejora en la mortalidad en
cirugías, enfermos críticos y sépticos
➔ Hamilton MA, Cecconi M, Rhodes A. A systematic review and meta-analysis
on the use of preemptive hemodynamic intervention to improve postoperative
outcomes in moderate and highrisk surgical patients. Anesth Analg. outcomes in moderate and highrisk surgical patients. Anesth Analg.
2011;112(6):1392–402.
➔ Sandham JD, Hull RD, Brant RF, Knox L, Pineo GF, Doig CJ, Laporta DP,
Viner S, Passerini L, Devitt H, Kirby A, Jacka M, Canadian Critical Care
Clinical Trials Group. A randomized, controlled trial of the use of
pulmonary-artery catheters in highrisk surgical patients. N Engl J Med.
2003;348:5–14.
Catéter de Swan Ganz
✔ Método INVASIVO INVASIVO con potenciales EFECTOS ADVERSOSEFECTOS ADVERSOS
Evans DC, Doraiswamy VA, Prosciak MP, Silviera M, SeamonMJ, Rodriguez Funes V, Cipolla J, Wang CF, KavuturuS, Torigian DA, Cook CH, Lindsey DE, Steinberg SM, StawickiSP. Complications associated with pulmonary arterycatheters: a comprehensive clinical review. Scand J Surg.2009;98(4):199–208.
Smart FW, Husserl FE. Complications of flow-directed balloontippedcatheters. Chest. 1990;97(1):227–8.
Edwardslifescience website. The FloTrac Sensor. 2014.
Monitoreo del gasto cardíaco mínimamente invasivo
✔ Sin calibración
✔ Flo Trac / Vigileo (Edwards Lifesciences, USA)
✔ LiDCO rapid (LiDCO UK)
✔ ProAQT (Pulsion medical system, Germany)
✔ Con calibración✔ Con calibración
✔ Termodilución transpulmonar
✔ PiCCO (PULSION Medical Systems, Germany)
✔ VolumeView (edwards lifesciens, USA)
✔ Dilución con Litio
✔ LiDCOplus (LiDCO UK)
(PiCCO2®)
✔ Aprobado para uso clínico en el año 2000.
✔ Aplica un algoritmo especial.
✔ Análisis continuo del contorno de pulso
✔ TPTD Termodilución intermitente transpulmonar.
Paciente de 5 años de edad neutropénico,
cursando shock séptico.
En ARM
Drogas
Dopamina 10 g/kg/min
Epinefrina 0,1 g/kg/min Epinefrina 0,1 g/kg/min
Norepinefrina 0,1 g/kg/min
Laboratorio
SvcO2 63 %
Láctico 3,8
TA 70/30 (TAM 48)
Paciente de 5 años de edad neutropénico,
cursando shock séptico.
En ARM
Drogas
Dopamina 10 g/kg/min
Epinefrina 0,1 g/kg/min Epinefrina 0,1 g/kg/min
Norepinefrina 0,1 g/kg/min
Laboratorio
SvcO2 63 %
Láctico 3,8
TA 70/30 (TAM 48)
IC 4,5
RVS 600
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