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• W1576186234 abstract "We read with great interest the article by Tagami and co-workers, regarding the precision of PiCCO® system (Pulsion Medical System, Munich, Germany) measurements in hypothermic patients post-cardiac arrest [1]. We congratulate the authors for attempting to evaluate the feasibility of a haemodynamic monitoring system in these particular patients. In this complex condition, called ‘post-resuscitation syndrome’ [2], a continuous monitoring system such as PiCCO may improve diagnosis and treatment, but the accuracy of its measurement in hypothermic patients after cardiac arrest would need to be validated and compared with other standardised techniques, since these data are lacking. Transpulmonary thermodilution is based on the premise that the temperature within the artery remains stable (<0.05 °C) during the calibration phase, and this may not occur during therapeutic hypothermia or during active warming. Hypothermia and body temperature variations produce ‘thermal noise’ that influence the accuracy of thermodilution measurements [3]. Ong et al. concluded that calibration of the PiCCO system should be undertaken before cooling and not repeated during therapeutic hypothermia [4]. Current data suggest that rapid induction of hypothermia after cardiac arrest is necessary in order to obtain an optimal neurological outcome and, on this basis, this should occur out of hospital by the emergency team or in the emergency department, where positioning of the PiCCO system is difficult. Thus, transpulmonary thermodilution measured before hypothermia may not always be possible. Moreover, the product information for the Pulsion PiCCO recommends recalibration of the pulse contour when the haemodynamic status of the patient changes. Therapeutic hypothermia has a complex and important influence on the cardiovascular system resulting in a decrease in myocardial contractility, heart rate and cardiac output [5] with significant increases in systemic vascular resistance [6], necessitating recalibration. Haemodynamic monitoring is desirable in hypothermic patients after cardiac arrest and the PiCCO system could be useful, but its accuracy must be validated before its extensive use in this particular condition. A non-temperature or metabolism-dependent technique would be the best technique for comparison and a pulse-contour technique without external calibration is, in our view, the solution." @default.
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• W1576186234 date "2012-08-02" @default.
• W1576186234 modified "2023-10-11" @default.
• W1576186234 title "The accuracy of PiCCO® measurements in hypothermic post-cardiac arrest patients" @default.
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• W1576186234 doi "https://doi.org/10.1111/j.1365-2044.2012.07281.x" @default.
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