LAUSR

Learning Objectives: The PiCCO (Pulse Index Continuous Cardiac Output) device (Pulsion Medical Systems, Feldkirchen, Germany) is a hemodynamic monitoring method integrating both static and dynamic hemodynamic data through a combination of pulse contour analysis and trans-cardiopulmonary thermodilution. According to common belief, functional hemodynamics cannot be used if the patient is not intubated and mechanically ventilated or if the patient is breathing spontaneously on an assisted mode. It is considered that one of the conditions necessary for correct interpretation is controlled mechanical ventilation (i.e. no spontaneous breaths). The aim of our study is to compare the measurements during assisted spontaneous breathing with or without sedation, and controlled mechanical ventilation in critically ill patients who underwent hemodynamic monitoring with PiCCO system. Methods: Our study is designed as a prospective and observational study. After the approval of the Research Ethics Committee of the Faculty of Medicine, patients who underwent hemodynamic monitoring with PiCCO were included. All patients were in sinus rythm and ventilated with a tidal volume ≥8 mL/kg. The first hemodynamic measurements were performed under pressure support ventilation (PSV) with no sedation, the second measurements were under sedation with midazolam and morphine. Finally the patients were ventilated with pressure control (PC) mode when they required neuromuscular blokade to achieve patient/ ventilator synchrony, then the measurements were repeated. The data was statistically analyzed in the Department of Biostatistics and Medical Informatics at the Faculty of Medicine. Results: Mechanically ventilated septic shock patients (tidal volume ≥ 8 mL/kg, PEEP ≤ 10 cmH2O, respiratory frequency ≤25/ min) were monitored with PiCCO system. Six patients (mean age 67,5 years, mean APACHE II-score 15,5) who required neuromuscular blockade during their follow-up were included in the study. We totally obtained 102 measures (during PSV with no sedation (n=34), PSV with sedation (n=34) and pressure control mode with neuromuscular blokade (n=34). Conclusions: We investigated whether the use of sedation is necessary during assisted spontaneous breathing for correct interpretation of measurements with PiCCO, especially dynamic parameters. We also compared the results with or without neuromuscular blokade. We found no statistically significant difference between the parameters (p=0,9993 for PPV, p=0,7308 for SVV). CCMCritical Care MedicineCrit Care Med0090-3493Lippincott Williams & WilkinsHagerstown, MDCCM