PiCCO技术简介概要.ppt

* The pulmonary capillary wedge pressure (PCWP) and alterations of this do not show any correlation with cardiac ejection either. Thus measurement of cardiac preload is not possible by means of the traditionally employed PCWP either. * FACCT study by the ARDS Networks, published in the New England Journal of Medicine: no difference in the outcome of ARDS patients with CVP-guided fluid management and those with volume therapy guided by the PCWP. Better: measure volumes directly instead of estimating them from the pressure measurement. The level of the filling pressures is subject to many influencing factors so a valid statement about volume status is not possible. Only exception: low filling pressures indicate hypovolaemia（血容量减少） * Introduction to the volumetric preload parameters. These allow direct measurement of the cardiac filling volume so that this does not have to be estimated through a pressure measurement. * The global end-diastolic volume consists of the end-diastolic volumes of all four cardiac chambers. Even if this volume does not exist physiologically (diastole of all four cardiac chambers is not simultaneous), it does reflect the filling status of the heart and is a valid parameter of cardiac preload compared to the filling pressures. * The correlation of the global end-diastolic volume with the cardiac stroke volume is considerably better than with CVP or PCWP. GEDV is thus much better suited for measuring the cardiac preload. * The intrathoracic blood volume corresponds to the global end-diastolic blood volume plus the blood in the pulmonary circulation. * The intrathoracic blood volume is usually 25% higher than the global end-diastolic blood volume. A linear association has been demonstrated for the two parameters. The ITBV can therefore be calculated from the GEDV. * The German Sepsis Society confirms in its official guidelines that volumetric parameters are superior to the classical filling pressures for assessing cardiac preload. GEDV and IT