hatte auf w:o mal ne Frage zum Vergleich Flotrac/Picco gestellt, bin dann aber in permanents post der FirstBerlin Studie auf folgende Passage gestoßen:
Besides its strong position on the less invasive market, Edwards is, as we have already seen, the market leader in the invasive segment. Edwards’ main less invasive product is FloTrac, launched in 2005. Our research on FloTrac indicates that the product is far less sophisticated than PiCCO. FloTrac is good at identifying trends in cardiac output but is not nearly as accurate as PiCCO. FloTrac also features a much lower range of parameters characterising the function of the cardiovascular system than PiCCO. Unlike PiCCO, FloTrac does not offer guidance on the kind or mix of therapeutic options which should be used. The fact that FloTrac is a very different product to PiCCO suggests to us there is room for both on the US market.
Auf w:o wurde wohl zurecht angemerkt, daß die Studie wohl zu 90% aus der Feder von Pulsion selbst stamm; deshalb habe ich weiter geforscht; folgende Artikel scheinen die Einschätzung aus der FirstBerlin/Pulsion Studie zu bestätigen:
ccforum.com/content/10/S1/P323
www.srlf.org/data/Upload/Consensus/pdf/189.pdf
bja.oxfordjournals.org/cgi/content/abstract/aem188v1
genau das gleiche auf Wikipedia:
Lidco hab ich jetzt mal rausgelassen, weil MA sehr klein.
en.wikipedia.org/wiki/Cardiac_output#Invasive_PP
Calibrated PP – PiCCO
PiCCO (PULSION Medical Systems AG, Munich, Germany) and PulseCO (LiDCO Ltd, London, England) generate continuous Q by analysis of the arterial PP waveform. In both cases, an independent technique is required to provide calibration of the continuous Q analysis, as arterial PP analysis cannot account for unmeasured variables such as the changing compliance of the vascular bed. Recalibration is recommended after changes in patient position, therapy or condition.
In the case of PiCCO, transpulmonary thermodilution is used as the calibrating technique. Transpulmonary thermodilution uses the Stewart-Hamilton principle, but measures temperatures changes from central venous line to a central arterial line (i.e. femoral or axillary) arterial line. The Q derived from this cold-saline thermodilution is used to calibrate the arterial PP contour, which can then provide continuous Q monitoring. The PiCCO algorithm is dependent on blood pressure waveform morphology (i.e. mathematical analysis of the PP waveform) and calculates continuous Q as described by Wesseling and co-workers.[9] Transpulmonary thermodilution spans right heart, pulmonary circulation and left heart; this allows further mathematical analysis of the thermodilution curve, giving measurements of cardiac filling volumes (GEDV), intrathoracic blood volume, and extravascular lung water. While transpulmonary thermodilution allows for less invasive Q calibration, the method is also less accurate than PA thermodilution and still requires a central venous and arterial line with the attendant infection risks.
[edit] Uncalibrated PP - FloTrac
This technology involves inserting a manometer tipped arterial catheter into the mid flow portion of an artery, usually radial or femoral, and then by time domain sampling converts the arterial PP to Q. While this method involves one less line than the calibrated PP Q systems, it remains un-calibrated and so is only measuring arterial PP invasively. While it estimates upstream Q, any independent changes in Q and SVR cannot be detected by this method. This method has yet to be extensively evaluated, but early studies suggest that it may be useful in stable, normal subjects.
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