PiCCO常见技术问题.ppt

PiCCO常见技术问题 PiCCO故障排除经验分享 PiCCO技术的热稀释参数在以下病人身上可能不准确: 瓣膜返流，室间隔缺损 主动脉瘤 肺切除病人 巨大肺栓塞 体外循环期间 严重心率紊乱 严重气胸 PiCCO参数影响因素 序号 疾病或治疗方法 影响参数 原因 1 心律失常 SVV、PPV参数为星号 SVV和PPV是30S计算一次 2 血温(TB)变化0.1℃ 注射冰盐水后所有参数不出 由于患者自身TB变化过大，机器分不出是注射盐水后引起的TB变化，还是患者自身TB变化，无法纳入计算。 3 使用IABP 所有连续参数 由于使用IABP会对患者的压力波形造成影响，所有通过动脉压力波形测得参数都无法显示。非连续参数无影响。 4 应用CRRT 基本无影响 但注意如血透管在股静脉，应不要把PiCCO导管置入同侧。同时注意TB变化。 5 肺大部切除、栓塞 血管外肺水偏小 由于肺切除或栓塞后，热稀释容积变小，血管外肺水偏小，建议参看趋势。 PiCCO and Dialysis 1 Heise D, Faulstich M, Morer O, Brauer, Quintel M Influence of continuous renal replacement therapy on cardiac output measurement using thermodilution techniques Minerva Anestesiol 2012; 78(3): 315-21 • • • • • • 32 ICU pts. who had either PAC (20) or PiCCO (12) and CRRT 5 thermodilution injections during CRRT, 5 after CRRT stopped and 5 after CRRT restarted Injections were 20mls at 8 °C (46.4 °F). Blood flow rate was 183 ± 35mL/min Vascular access for CRRT catheter was femoral (27), subclavian (3) or internal jugular vein (2) PiCCO placed in femoral artery 1 PiCCO and Dialysis 2 • • • • • The first measurements in each series after switching CRRT OFF or ON deviated the most from the average When these first measurements were excluded CO differed by 7% Subsequent CO measurements did not depend on CRRT status. Interrupting CRRT before measuring CO is not generally recommended. However, if interrupted WAIT for the blood temperature to reach a steady state before initiating measurements 2 3 • • • 69 pts. on CVVH (femoral = 62 or jugular vein = 7) and PiCCO2(femoral artery) Blood pump flow rate 250mL/min or 350mL/min Filtration flow 6000mL/hr PiCCO and Dialysis 3 Dufour N, Delville M, Teboul JL, Camous L, Favier du Noyer A, Richard C, Monnet X Transpulmonary thermodilution measurements are not affected by continuous veno-venous hemofiltration at high blood pump flow Intensive Care Med 2012; 38(7): 1169 – 76 • • • TDCIon was same as PCoff and TDCIoff regardless of blood flow (250 or 350 mls) No change in GEDI whether pump was on