This chapter is relevant to Section G7(iv)  of the 2017 CICM Primary Syllabus, which asks the exam candidate to "describe the methods of measurement of cardiac output including calibration,
sources of errors and limitations". 

Indications for use of PiCCO: 

 

  • Guidance of fluid management in patients with complex hemodynamic failure, eg. combination septic and cardiogenic shock
  • Unavailability of, or contraindications to, the use of PA catheters

Contraindications for use of PiCCO:    

      

  • Atrial or ventricular arrhythmia:  you need a stable pulse to measure the contour of
  • Intra-Aortic Balloon pump:  once again, the pulse contour is all wrong; but you can still get thermodilution cardiac output measurements.
  • Aortic aneurysm: the contour will be bizarre because the arterial compliance is going to be weird, with the aortic aneurysm acting as a damping system by absorbing all the pressure wave.
  • Extracorporeal circuit: when you are on bypass, there is no real arterial waveform
  • Pneumonectomy: PiCCO relies on there being a relatively normal pulmonary vasculature
  • Massive pulmonary embolism: as above; it is essentially a pneumonectomy by embolism.
  • Intracardiac shunt:  the PA catheter will also give an inaccurate thermodilution reading

References

From Bersten and Soni’s” Oh's Intensive Care Manual”, 6th Edition, as well as http://www.pulsion.com/ who are sadly the best source for this sort of information.