Over a period of 6 months we considered for inclusion all adult patients (≥ 18 years) who required hemodynamic monitoring using TPTD because of hemodynamic instability (defined by a combination of vasopressor therapy needed to maintain a mean arterial pressure ≥ 65 mmHg and serum lactate above 2 mmol/L despite adequate fluid resuscitation) and had both a PICC and a CICC in place. The study was conducted in the general Intensive Care Unit (ICU) of the Fondazione Policlinico Universitario “A. All patients or their legal representatives gave their written informed consent to participate. This study ( NCT04241926) was approved by the institutional review board (Prot. The aim of our study was to evaluate whether triple-lumen 6Fr or single-lumen 5Fr PICCs could be as accurate as 7Fr CICCs (standard reference) for hemodynamic measurements with TPTD using the VolumeView/EV1000™ system. We hypothesized that using PICCs with a larger lumen size might reduce resistance to flow and ensure more accurate a measurement. The most likely reason for this was the greater resistance to flow during bolus injection through these PICCs, due to their smaller size of their lumen, leading to an increased temperature of the fluid bolus and a consequent reduced difference (ΔT) between the temperature of the injected bolus and the blood temperature measured by the femoral arterial thermistor. In a previous study from our group we found that cold fluid bolus injection through a single-lumen 4Fr or a double-lumen 5Fr PICC for TPTD using VolumeView/EV1000™ significantly overestimated cardiac index (CI) and other TPTD-derived measures when compared with injection through the distal lumen of a 7Fr CICC. Several studies demonstrated that PICCs are equivalent to centrally inserted catheters (CICCs) for central venous pressure (CVP) measurement but there is no evidence they can replace CICCs for cardiac output measurement using TPTD. Power injectable polyurethane peripherally inserted central catheters (PICCs) allow high-speed fluid infusion (up to 3–5 mL/s), which makes them potentially suitable for cold fluid bolus injection during trans-pulmonary thermodilution (TPTD). Conclusionsĭuring hemodynamic monitoring with TPTD, both single-lumen 5Fr PICCs and triple-lumen 6Fr PICCs can be used for cold fluid bolus injection as an alternative to CICC ( NCT04241926). Similar results were observed for TPTD-derived parameters. triple-lumen 7Fr CICC was below 20% (14.7% and 19% during the manual phase and 14.4% and 13.8% during the automated phase, respectively). For both single-lumen 5Fr and triple-lumen 6Fr PICCs, percentage error vs. During the automated phase, triple-lumen 6Fr PICC slightly overestimated the cardiac index when compared to triple-lumen 7Fr CICC (CI 3.4 ± 0.7 vs. During the manual phase, the cardiac index measured with either single-lumen 5Fr or triple-lumen 6Fr PICCs were comparable with cardiac index measured with triple-lumen 7Fr CICC (3.2 ± 1.04 vs. ResultsĪ total of 320 measurements were performed in 15 patients. We performed Bland–Altman analysis accounting for multiple observations per patient. To rule out biases related to manual injection, measurements were repeated using an automated rapid injection system. We compared TPTD measurements via single-lumen 5Fr or triple-lumen 6Fr polyurethane power injectable PICCs with triple-lumen 7Fr CICC (reference standard). This is a single-centre, prospective method–comparison study that included adult patients admitted in ICU who required a calibrated Pulse Contour hemodynamic monitoring system (VolumeView/EV1000™) for circulatory shock and had both PICC and CICC in place. We hypothesize that PICCs with larger lumen size may be reliable for the cardiac index assessment using the TPTD. Single-lumen 4Fr or double-lumen 5Fr power injectable peripherally inserted central catheters (PICCs) are not accurate for trans-pulmonary thermodilution (TPTD), since they overestimate cardiac index and other TPTD-derived parameters when compared with centrally inserted central catheters (CICCs) because of the smaller size of their lumen.
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