Pulsion Medical Systems Se: Pulsioflex Picco Data Interpretation

PULSION Medical Systems SE PulsioFlex PiCCO data interpretation

PULSION is part of Maquet Getinge Group

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PULSION is part of Maquet Getinge Group

Guidance for parameter interpretation General analysing of results – verification of validity Patient data plausible Pressure curve quality sufficient, no extra systoles or arrhythmias

Injected volume adequate

CVP value plausible

Pressure values & heart rate plausible

Thermodilution values reproducible and plausible ΔT sufficiently high (good signal) Tinj sufficiently low (cold injectate)

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Optimal thermodilution curves

PULSION is part of Maquet Getinge Group

Guidance for parameter interpretation General analysing of results – the parameters

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Blood flow (CI) Preload volume (GEDI) Volume responsiveness (SVV), if applicable Afterload (SVRI) Contractility (CFI) Pulmonary Oedema (ELWI) Origin of pulmonary oedema (PVPI)

Trend important!

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Blood flow (Volume responsiveness)

Afterload

Contractility

Preload Pulmonary oedema

PULSION is part of Maquet Getinge Group

Guidance for parameter interpretation Example 1 Normal ranges CI

3 – 5 l/min/m2

GEDI SVV

680 – 800 ml/m2 0 – 10 %

SVRI

1700 – 2400 dyn·sec·cm-5·m2

CFI CPI

4.5 – 6.5 1/min 0.5 – 0.7 W/m2

ELWI PVPI

3 – 7 ml/kg 1 – 3 cardiogenic oedema > 3 permeability oedema

Conclusion: Low blood flow due to low preload and high vascular resistance: hypovolaemia Therapeutic recommendations: - Fluid loading - Vasodilator - Repeated thermodilution measurement after therapy

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PULSION is part of Maquet Getinge Group

Guidance for parameter interpretation Example 2 Normal ranges CI

3 – 5 l/min/m2

GEDI SVV

680 – 800 ml/m2 0 – 10 %

SVRI

1700 – 2400 dyn·sec·cm-5·m2

CFI CPI

4.5 – 6.5 1/min 0.5 – 0.7 W/m2

ELWI PVPI

3 – 7 ml/kg 1 – 3 cardiogenic oedema > 3 permeability oedema

Conclusion: High blood flow with low vascular resistance and high lung water due to high permeability: Hyperdynamic circulation, permeability pulmonary oedema (sepsis, ARDS)

Therapeutic recommendations: - Supportive therapy: ventilator settings, lung support (CARDIOHELP), kinetic therapy - Vasoconstrictor - Repeated thermodilution measurement after therapy Page 6

PULSION is part of Maquet Getinge Group

Guidance for parameter interpretation Example 3 Normal ranges CI

3 – 5 l/min/m2

GEDI SVV

680 – 800 ml/m2 0 – 10 %

SVRI

1700 – 2400 dyn·sec·cm-5·m2

CFI CPI

4.5 – 6.5 1/min 0.5 – 0.7 W/m2

ELWI PVPI

3 – 7 ml/kg 1 – 3 cardiogenic oedema > 3 permeability oedema

Conclusion: Low blood flow with high vascular resistance, severe pulmonary oedema due to high preload (fluid overload) and low contractility: cardiac failure, cardiogenic pulmonary oedema (cardiogenic shock) Therapeutic recommendations: - Fluid withdrawal - Inotropic drugs - Repeated thermodilution measurement after therapy

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PULSION is part of Maquet Getinge Group

Be aware of pros and cons! Possible consequences of therapeutic decisions

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PULSION is part of Maquet Getinge Group