The Significance Of PiCCO Monitoring System In The Fluid Management Of Critically Ill Patients With Acute Respiratory Distress Syndrome

Introduction: Acute Respiratory Distress Syndrome is a critical illness results from injury tothe alveolar-capillary membrane. This damage causes increased vascular permeability andexudation of plasma into the alveoli leading to pulmonary edema. This is the mainpathophysiological change in the patients with ARDS. Inadequate circulating volume andpulmonary edema, both are major problems in the treatment of ARDS. Restricted fluidtherapy to reduce pulmonary edema is the most common clinical strategy used so far. Thecurrent study found that maintaining circulatory volume and ensuring organ perfusion,restrictive fluid management strategy in the patients with ARDS is beneficial. In this situationconventional monitoring tools have a big limitation. Hemodynamic monitoring with the helpof PiCCO in the patients with ARDS provides real time monitoring and guides the treatmentof the patients with ARDS. Therefore, by means of PiCCO hemodynamic monitoring tool weretrospectively analyzed hemodynamic characteristics and prognosis of patients with ARDS.It provides some opinions in relation to fluid management in the patients with ARDS as well.We sought to estimate the effect of PiCCO monitoring system for the management of acuterespiratory distress system.Methods: Retrospective study of26patients with ARDS treated in the intensive care unit ofthe second hospital of Jilin University, dated from2010.7-2013.7was performed. Patientswere divided in two groups: ARDS with PiCCO monitor (n=13) and ARDS without PiCCO(n=13) i.e.the conventional therapy group. Both the groups were provided mechanicalventilator support with PEEP≥5cmH2O. Patients with cardiogenic pulmonary edema, patientshaving contraindications to catheterization, having diabetes, liver and kidney diseases wereexcluded. Hemodynamic parameters such as extra vascular lung water index (EVLWI),cardiac index (CI), global end diastolic volume (GEDV), systemic vascular resistance index(SVRI) and pulmonary vascular permeability index (PVPI) were measured within one hour(0hour) of ICU admission, after6hours,12hours,24hours,48hours and72hours in thePiCCO group. At the same time, blood lactate and PaO2were recorded at0,6,12,24,48and72hours after admission. Oxygenation index (PaO2/FiO2ratio) was also calculated. In thesame way, blood lactate and PaO2was observed, oxygenation index was calculated in the non-PiCCO group at zero hour and6,12,24,48and72hours after admission. GCS score,serum bilirubin level, creatinine level, blood urea nitrogen, platelet count, blood pressure anddrugs used were carefully monitored in both the groups. SOFA score, total mechanicalventilator days were recorded. The mortality rates after3months were figured out in both thegroups.Results:1. In the PiCCO group, GEDVI and EVLWI were found to be significantly correlated6-72hours after admission (r=0.84, P<0.05). P<0.05is considered statistically significant.2. The correlation between EVLWI and Lactate levels in the patients with ARDS withPiCCO monitoring tool was observed to be positively correlated (r=0.88, P<0.05).3. We also found that EVLWI and oxygenation index (PaO2/FiO2ratio) in the PiCCO grouphas a significant negative correlation (r=-0.87, P<0.05).4. Comparing the PiCCO and conventional non PiCCO group in terms of SOFA72hr,mortalityand duration of mechanical ventilation, we observed5.4±1.7Vs6.8±1.4(P<0.05),46.2%Vs61.5%(P<0.05), and7.4±2.3Vs9.6±3.4(P<0.05) days respectively.5. Blood Lactate level in the patients with PiCCO insertion found to be lower at24hours,48hours and72hours in comparison to the conventional non PiCCO group. P<0.056. The PiCCO group compared with the conventional group showed a higher oxygenationindex (PaO2/FiO2) at72hours after admission to the ICU. P<0.05Conclusion: PiCCO allows continuous hemodynamic monitoring of critically ill patientswith ARDS. The PiCCO helps the clinicians to record EVLWI, GEDVI and CI which cannotbe monitored by basic monitoring system applied in non-PiCCO group of patients. EVLWguided fluid management and relative adjustment by consideration of all aspects of cardiacfunction could improve clinical outcomes in the patients with ARDS. PiCCO applied patientscould have better clinical outcomes in terms of increased tissue perfusion and oxygenation,and decreased blood lactate level, reduced SOFA score and decreased length of ICU stay,decreased mortality rate and ventilator days in comparison to a non PiCCO group of patients.