HaemodynamicMonitoring.pptVIP

The first PiCCO values in this patient show a preload volume in the mid normal range, markedly raised extrapulmonary lung water and drastically reduced peripheral resistance. Because of the low peripheral resistance, the noradrenaline therapy is continued. To improve cardiac output, the volume therapy is continued with monitoring of the GEDI and ELWI in view of the still relatively low preload volume despite the increased lung water On the following day it is apparent that the preload could be kept in the upper normal range with repeated PiCCO measurement without aggravating the pulmonary oedema. Despite giving noradrenaline, the peripheral resistance continues to be very low (vasoplegia) In the further course, haemodynamic stabilisation was achieved so that the noradrenaline requirement did not increase further and cautious negative volume balance could be begun. The patient‘s stabilisation and negative volume balance are reflected in the markedly reduced extravascular lung water with continuing normal preload volume. Despite stopping the vasopressor therapy, the peripheral resistance is now within the normal range. The course of the measurements shows on the one hand how the PiCCO parameters GEDI and ELWI were used to guide therapy. On the other hand, it is also apparent that the CVP, which is often used in clinical practice for guiding volume management, was raised initially although clinically there was marked volume depletion. Measurement of the cardiac output on its own without taking preload volume and lung water into account would not have been useful as a guide since the cardiac index remained relatively constant despite administration and removal of volume. PiCCO technology in this case enabled optimisation of intravascular volume status on the one hand while on the other hand further deterioration of lung function could be avoided by simultaneous monitoring of the pulmonary oedema. In this way, the PiCCO parameters supported prompt haemodynamic stabili