Experiencia clínica de monitorización hemodinámica del shock mediante el sistema PiCCO^®

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/m², cardiac index (CI) 4.04 (2.58-6.25) to 4.48 (2.86-8.71)lmin-1m², 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.