CRRT influences PICCO measurements in febrile critically ill patients

Abstract

The aim of this study was to investigate whether continuous renal replacement therapy (CRRT) influences the global end-diastolic volume index (GEDVI), cardiac index (CI), and extravascular lung water index (EVLWI) measured by Pulse Index Continuous Cardiac Output (PICCO) in febrile patients. Fifteen fever patients were included in this study. CI, GEDVI, EVLWI, heart rate (HR), and mean arterial pressure (MAP) were measured at five time-points: before CRRT (T0), immediately after CRRT started (T1), 15 min after CRRT started (T2), immediately after CRRT stopped (T3), and 15 min after CRRT stopped (T4). Results have shown that CI and GEDVI were decreased significantly in T1 (CI: 4.09 ± 0.72 vs 2.81 ± 0.58 L/min m2, P = 0.000 and GEDVI: 727.86 ± 63.47 vs 531.07 ± 66.63 mL/m2, P = 0.000). However, CI and GEDVI were significantly increased in T3 (CI: 4.09 ± 0.72 vs 7.23 ± 1.32 L/min m2, P = 0.000 and GEDVI 727.86 ± 63.47 vs 1339.17 ± 121.52 mL/m2, P = 0.000). There were no significant differences in T2 and T4. Among the five-time points, no measurement errors were observed with regards to HR, MAP, and EVLWI. Therefore, the data herein contained suggests that PICCO measurements should begin 15 min after the start or stop of CRRT.

Airway pressure release ventilation (APRV) versus pressure support ventilation (PSV)—A prospective intervention trial comparing haemodynamic parameters in intensive care patients

“…27 However, studies suggest that the mean effects are usually clinically negligible ($0.1 L/min) and that larger differences are mainly found during the start and end of CRRT. 27,28 Moreover, a potential bias would not impact the change in cardiac index measured here. Lastly, we would have preferred having a more recent echocardiographic exam of each of the included patients to know if there were any underlying cardiac dysfunctions which affected the PiCCO outputs.…”

“…Some of our patients had ongoing CRRT, which can influence the accuracy of PiCCO measurements of cardiac index compared to a pulmonary artery catheter 27 . However, studies suggest that the mean effects are usually clinically negligible (~0.1 L/min) and that larger differences are mainly found during the start and end of CRRT 27,28 . Moreover, a potential bias would not impact the change in cardiac index measured here.…”

Injection Site Matters: A Comparative Analysis of Transpulmonary Thermodilution via Simultaneous Femoral and Jugular Indicator Injections under Veno-Venous Extracorporeal Membrane Oxygenation Therapy

“…It is worth noting that the literature on LOI in other extracorporeal support systems, such as renal replacement therapy, is not clear. Some studies found no relevant differences in PiCCO parameters under ongoing extracorporeal blood flow [17,18], while others suggest that even the lower extracorporeal volume of renal replacement therapy compared to ECMO blood flow may have an impact on the thermodilution method in patients with fever [19]. However, it should be noted that the studies by Sakka et al were conducted in ICU patients with preserved cardiac output (CI: 3.8 ± 1.4 L/min/m 2 ), and the extracorporeal blood flow was low (mean: 112.9 mL/min) [17].…”