ICU中PiCCO的应用.ppt

PMAN\FREIDOKU\SCHULUNG\PiCCO\high_level\PiCCO_highLevelV05_04_02 PMAN\FREIDOKU\SCHULUNG\PiCCO\PiCCO_highLevelV04_08_00 PMAN\FREIDOKU\SCHULUNG\PiCCO\PiCCO_highLevelV04_08_00 PiCCO容量监护仪在ICU中的应用 正确的监测才能进行正确的治疗 什么是PiCCO？ PiCCO是一种技术，是一种简便、微创、高效费比的，对重症病人主要血流动力学参数进行监测的工具。 PiCCO不仅是 心排量监测仪 治疗指南－Surviving Sepsis Campaign Guidelines 2008: ? 灌注压在评估扩容治疗中已经被证实有局限性 ... 使用血流量或者容量参数指导容量管理或许更有优势 … 这些技术已经能够在ICU内实现 …? CFI—心脏收缩功能指数 PiCCO心肌收缩力参数 EVLW—肺水肿指数 监测ELWI能够发现肺水10-15%的增加 X-ray只有在肺水100-300%增长时才能甄别 谢 谢 ！ Configuration What is needed to accomplish art. thermodilution cardiac output pulse contour cardiac output? Any central venous line. Injectate temperature sensor for detection of the cold bolus. The injectate temperature sensor (PV4045) is included in the monitoring kit (e.g. PV8015) 22G - 5F Thermodilution catheter with lumen for arterial pressure, placed in the Femoral artery or the Axillary artery. The reason that a large artery needs to be accessed is that the catheter needs to have blood flow around it to detect a temperature change. Are you aware that a traditional radial arterial line does not have blood flow?Only 30% of the patients with a radial artery line have blood flow around catheter. 70 % do not have flow. Arterial pressure transducer * The relevance of the filling pressures for assessing cardiac preload has long been disputed and has been refuted in numerous publications. Neither the absolute level of the CVP (shown on left) nor the changes in CVP (shown on right) correlate with stroke volume. CVP therefore not suitable for assessing volume status. 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. In this case the CVP value is useless for therapuetic decisioon making. When preload and pulmona