PulsioFlex and PiCCO Customer

Presentation

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 PulsioFlex 5.1 summary features

PulsioFlex 3.0 PulsioFlex 5.1

Windows operating system WinXP Win7

Connectivity No HL7 HL7

HIPAA compliant No Yes

New parameters No Yes

Enhanced visualization No Yes

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 Expanding Getinge’s Advanced Patient Monitoring Portfolio

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 Windows OS & HL7

• Win7 Operating System

- More stable operating system

• Connectivity to PDMS via HL7

- State of the art connectivity
- Standard communication protocol for medical/health care
environment

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 HIPAA compliance

• Getinge leading the charge - enabling HIPAA

compliance monitoring
• PulsioFlex includes an option to exclude patient
information in printout and data recording to
fulfill HIPAA requirements.
• Feature is already activated by default at the
factory

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 HIPAA compliance

• Once activated (password secured setting):

• all ePHI patient data will be masked in Print and Data
Acquisition. ePHI data items will be replaced by “*****”.
• all ePHI data will be lost at system shutdown (no more
available after reboot), since ePHI data is not saved to the
system.
• Data Output via RS232 (see 5.2.3) is not affected by the
HIPAA settings.

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 OrganView

• New graphical overview screen that shows

selected parameters visualized in
relationship to the lung, heart and vessels
• Features a traffic light system that informs,
alerts and helps clinicians to make rapid,
informed decisions

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 OrganView

Traffic light system:

within normal range
slightly out of range
more than 20% out of
normal range

Intermittent (left side) & continuous (right side)

parameters

TD: information when the last thermodilution

measurement was performed

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 OrganView

Lungs: Alveoli with water content & permeability

Heart: preload volume

Vessels: vascular resistance

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 OrganView
Interpretation – Case #1

Lungs:
No edema, no permeability damage

Heart:
Low blood flow, low preload volume
slightly impaired contractility

Vessels:
High vascular resistance

Conclusion: Hypovolemia

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 OrganView
Interpretation – Case #2

Lungs:
Severe edema, severe permeability damage

Heart:
High blood flow, low preload volume
high contractility

Vessels:
Low vascular resistance

Conclusion: ARDS

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 OrganView
Interpretation – Case #3

Lungs:
Severe edema, severe permeability damage ??

Heart:
High blood flow, normal preload volume ??
high contractility

Vessels:
Normal vascular resistance ??

Conclusion: Inappropriate target range setting

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 Volume Tests
• Physicians perform fluid responsiveness tests on
a regular basis, but track them manually.
• The new software features an integrated test
tracking tool called Volume Test
• 3 test methods are included:
• Fluid Challenge
• Passive Leg Raising (PLR)
• End Expiratory Occlusion (EEO)

• PLR is a reliable test to determine fluid

responsiveness with strong sensitivity and
specificity1
• End Expiratory Occlusion (EEO) can be used to
determine if the patient is fluid responsive. 1. Cavallaro F et al., Diagnostic accuracy of passive leg raising for prediction of fluid
responsiveness in adults: systematic review and meta-analysis of clinical studies.
Intensive Care Med 2010; 36(9):1475-83.

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 Volume Tests

1) Select Volume Test Method

a. Fluid Challenge
b. PLR
c. EEO

Select for more detailed information about the

selected test method

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 Volume Tests

2) Configure test setting

a. Tested Parameter (lead parameter
cannot be changed)
b. Volume
c. Target Value
d. Duration

Press Start to start the test

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 Volume Tests

3) Parameter Tracking

The tracking window can be closed by selecting

the “hide” button- the test will continue.

The window will automatically be re-opened as

soon as:
• the test time is elapsed,
• the overall observation time (test time +
buffer time) is elapsed,
• the lead parameter reaches the target value.
In all cases, there is also an audio visual
message.

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 Volume Tests

4) Review Results

Move the lines with the drag handles to calculate

the change of the lead parameter between any two
points at the curve.

Use the expand button to show the curves of the

other tracked parameters.

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 Expanding PiCCO parameters

• Increased PiCCO
parameters from 9 to 13
• 4 new PiCCO parameters

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 Pulmonary Vascular Permeability Index (PVPI)

Quantification of pulmonary edema = Pulmonary Vascular Permeability Index (PVPI)

The PVPI can help to distinguish between cardiogenic and permeability caused pulmonary edema.

The equations for the calculated parameter:

PVPI = EVLW / PBV

where PVPI = Pulmonary Vascular Permeability Index (no unit)
EVLW = Extravascular Lung Water (ml)
PBV = Pulmonary Blood Volume (ml) (ITBV - GEDV)

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 Pulmonary Vascular Permeability Index (PVPI)

• 2 main types of pulmonary edema

• PVPI is able to differentiate the
diagnosis of cardiogenic pulmonary
edema vs permeability pulmonary
edema
• Cardiogenic pulmonary edema a
negative fluid balance is sought,
while in permeability pulmonary
edema treating the cause of
inflammation is the priority
• PVPI value in the range of 1 to 3
points to cardiogenic pulmonary
edema and PVPI greater than 3
suggests a permeability pulmonary
edema.

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 Pulmonary Vascular Permeability Index (PVPI)

PVPI* – Pulmonary Vascular Permeability Index

• PVPI represents the ratio between Extravascular Lung Water (EVLW) and Pulmonary Blood Volume (PBV)
• In case of increased lung water, it enables differentiation between:
 Cardiogenic pulmonary edema (fluid overloading, cardiac insufficiency)
 Permeability pulmonary edema (sepsis, inflammatory response, ARDS)

Monnet X et al. Assessing pulmonary permeability by transpulmonary thermodilution allows differentiation of hydrostatic pulmonary edema from ALI/ARDS. Intensive Care Med 2007
Kushimoto S et al. The clinical usefulness of extravascular lung water and pulmonary vascular permeability index to diagnose and characterize pulmonary edema: a prospective multicenter study on the quantitative differential diagnostic definition
for acute lung injury/acute respiratory distress syndrome. Crit Care 2011; 16(6): R232
Kor DJ et al. Extravascular lung water and pulmonary vascular permeability index as markers predictive of postoperative acute respiratory distress syndrome: A prospective cohort investigation. Crit Care Med 2014; 43(3): 665-73

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 Pulmonary Vascular Permeability Index (PVPI)

Assessing pulmonary permeability by transpulmonary thermodilution allows differentiation of hydrostatic pulmonary edema from ALI / ARDS
Monnet X, Anguel N, Osman D, Hamzaoui, Richard C, Teboul JL
Intensive Care Medicine 2007; 33(3): 448-53
This article tested whether the pulmonary vascular permeability index (PVPI) from the PiCCO transpulmonary thermodilution measurement was able to
differentiate between different forms of pulmonary edema (1. permeability pulmonary edema - direct damage caused by for e.g. Acute Lung Injury – ALI or Acute
Respiratory Distress Syndrome – ARDS or 2. hydrostatic pulmonary edema caused by for e.g. cardiac failure or fluid overload).
In this article the authors describe/discuss the following:
1. The authors looked at the records of 48 critically ill patients with acute respiratory failure and pulmonary edema (extravascular lung water greater than 12
ml/kg) which had the PVPI measured from the PiCCO.
2. Three expert doctors then reviewed the patients clinical notes and test results (except for the above PVPI) and stated what they thought the cause of the
pulmonary edema was.
3. In patients identified as having pulmonary edema caused by ALI /ARDS the PVPI was, on average, 4.7 and in patients identified as having hydrostatic
pulmonary edema it was only 2.1.
4. The authors state that a PVPI ≥ 3 is highly sensitive and specific for a pulmonary edema caused by ALI /ARDS (permeability caused pulmonary edema).

Takeaways:
• Differentiates between the different causes of pulmonary edema and is important because their therapeutic management differs.
• This article confirms the clinical usefulness of the PiCCO parameter PVPI for showing the cause of a patient’s pulmonary edema and thereby aiding more
successful and appropriate treatment.

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 Global Ejection Fraction (GEF)

Definition
Ejection fraction represents the percentage of volume
in a heart chamber which is ejected with a single
contraction.

Clinical Relevance
The measurement of the Global Ejection
Fraction offers a complete picture of the overall
cardiac contractility.

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 CPO/CPI (Cardiac Power Output/Cardiac Power Index)

Definition
CPO = COPC  MAP  0.0022
CPO represents the power of left ventricular cardiac where CPO = Cardiac Power Output (W)
COPC = Continuous Pulse Contour Cardiac Output (l/min)
output. MAP = Mean Arterial Pressure (mmHg)

CPI = CIPC  MAP  0.0022

where CPI = Cardiac Power Index (W/m2)
Clinical Relevance CIPC = Pulse Contour Cardiac Output Index (l/min/m2)
In clinical studies, it has been found to be the MAP = Mean Arterial Pressure (mmHg)

strongest independent predictor of hospital mortality

in cardiogenic shock patients.1) 2)

1) Mendoza DD, Cooper HA and Panza JA, Cardiac power output predicts mortality
across a broad spectrum of patients with acut cardiac disease. Am Heart J 2007;
153(3): 366-70.
2)Fincke R et al., Cardiac power is the strongest hemodynamic correlate of
mortality in cardiogenic shock: a report from the SHOCK trial registry. J Am Coll
Cardiol 2004; 44(2): 340-8.

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 Intrathoracic Blood Volume (ITBV/ITBI)

• Origionally measured with the COLD system

• Parameter was always required to calculate EVLW, but
now is visible independantly
• In a clinical study using double-indicator dilution technology
to measure ITBV and EVLW1, it was found that
Intrathoracic Blood Volume is consistently 25% higher than
the Global End-Diastolic Volume.
• More current teachings suggest to evaluate GEDI
concerning cardiac preload volume

1. Sakka SG et al. Assessment of cardiac preload and extravascular lung water by

single transpulmonary thermodilution. Intensive Care Med 2000; 26(2): 180-187

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 Help screens

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 Help screens

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 Help screens

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 Thank you!

www.getinge.com

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