CLINICAL UTILITY OF PiCCO FOR PROGNOSTICATION IN CRITICALLY ILL PATIENTS: A NARRATIVE REVIEW
DOI:
https://doi.org/10.31435/ijitss.4(52).2026.6282Keywords:
PiCCO, Hemodynamic Monitoring, Intensive Care Unit, ARDS, SepsisAbstract
Background: Hemodynamic instability remains one of the leading causes of morbidity and mortality among critically ill patients. The Pulse Contour Cardiac Output (PiCCO) system combines transpulmonary thermodilution with pulse contour analysis, supporting comprehensive assessment of cardiac output, preload, cardiac performance, pulmonary edema, and fluid responsiveness. Although widely used in intensive care, its prognostic value remains a matter of ongoing debate.
Objective: This narrative review aimed to evaluate the current evidence regarding the prognostic utility of PiCCO-derived hemodynamic parameters in adult critically ill patients.
Methods: A narrative review of studies published between 2000 and 2025 was executed using PubMed/MEDLINE, Scopus, and Web of Science. Studies evaluating PiCCO-derived parameters in relation to clinically relevant outcomes, including mortality, organ dysfunction, fluid responsiveness, and intensive care unit (ICU) length of stay, were included.
Results: Among the analyzed parameters, the extravascular lung water index (EVLWI) demonstrated the strongest and most consistent association with mortality, particularly in patients with sepsis and acute respiratory distress syndrome (ARDS). The cardiac function index (CFI) provided additional prognostic value in septic patients by identifying myocardial dysfunction not reflected by conventional cardiac output measurements. Dynamic parameters, including stroke volume variation (SVV), reliably predicted fluid responsiveness in selected populations, especially septic shock and post-cardiac surgery patients. However, evidence supporting an overall mortality benefit of PiCCO-guided management among varied ICU populations remains limited, whereas ARDS-specific studies show better clinical outcomes.
Conclusions: PiCCO yields valuable multidimensional hemodynamic assessment and offers clinically meaningful prognostic information, particularly through EVLWI and CFI. Nevertheless, its greatest benefit appears to depend on appropriate patient selection and adoption into structured, population-specific treatment algorithms rather than the monitoring technology alone.
References
Alhashemi, J. A., Cecconi, M., & Hofer, C. K. (2011). Cardiac output monitoring: An integrative perspective. Critical Care, 15(2), 214–214. https://doi.org/10.1186/cc9996
Bateman, R. M., Sharpe, M. D., Jagger, J. E., Ellis, C., Violán, J., Rodríguez, M. L., Ramos, E., Ruiz-Hernández, J., Borderías, L., Horcajada, J. P., González-Quevedo, N., Rajas, O., Briones, M. L., Castro, F. R., Gallego, C., Esen, F., Orhun, G., Özcan, P. E., & Prandi, E. (2016). 36th international symposium on intensive care and emergency medicine. Critical Care, 20, 347–347. https://doi.org/10.1186/s13054-016-1208-6
Cecconi, M., Backer, D. D., Antonelli, M., Beale, R., Bakker, J., Hofer, C. K., Jaeschke, R., Mebazaa, A., Pinsky, M. R., Teboul, J., Vincent, J., & Rhodes, A. (2014). Consensus on circulatory shock and hemodynamic monitoring. Task force of the European Society of Intensive Care Medicine. Intensive Care Medicine, 40(12), 1795–1815. https://doi.org/10.1007/s00134-014-3525-z
Chaudhary, Maj. Gen., C. S. A., Shiv Kumar Gupta2, & Arif (2026). Precision-oriented hemodynamic monitoring in critical care practice: Evidence-based strategies, clinical integration, and outcome optimization. https://doi.org/10.5281/zenodo.18928718
Connors, A. F. (1996). The effectiveness of right heart catheterization in the initial care of critically III patients. JAMA, 276(11), 889–889. https://doi.org/10.1001/jama.1996.03540110043030
Cordemans, C., Laet, I. D., Regenmortel, N. V., Schoonheydt, K., Dits, H., Huber, W., & Malbrain, M. L. N. G. (2012). Fluid management in critically ill patients: The role of extravascular lung water, abdominal hypertension, capillary leak, and fluid balance. Annals of Intensive Care, 2. https://doi.org/10.1186/2110-5820-2-s1-s1
Gattinoni, L., Brazzi, L., Pelosi, P., Latini, R., Tognoni, G., Pesenti, A., & Fumagalli, R. (1995). A trial of goal-oriented hemodynamic therapy in critically ill patients. New England Journal of Medicine, 333(16), 1025–1032. https://doi.org/10.1056/nejm199510193331601
Gavelli, F., Shi, R., Teboul, J., Azzolina, D., Mercado, P., Jozwiak, M., Chew, M. S., Huber, W., Kuzkov, V. V., Lahmer, T., Malbrain, M. L. N. G., Mallat, J., Sakka, S. G., Tagami, T., Pham, T., & Monnet, X. (2022). Extravascular lung water levels are associated with mortality: A systematic review and meta-analysis. Critical Care, 26(1), 202–202. https://doi.org/10.1186/s13054-022-04061-6
Hofer, C. K., Senn, A., Weibel, L., & Zollinger, A. (2008). Assessment of stroke volume variation for prediction of fluid responsiveness using the modified FloTracTM and PiCCOplusTM system. Critical Care, 12(3). https://doi.org/10.1186/cc6933
Huang, Y., Zhao, Z., Sun, W., & Zuo, J. (2022). Effect of PULSE indicator continuous cardiac output monitoring on prognosis of patients with acute respiratory distress syndrome: A meta-analysis. In Research Square. https://doi.org/10.21203/rs.3.rs-2256016/v1
Huygh, J., Peeters, Y., Bernards, J. A., & Malbrain, M. L. N. G. (2016). Hemodynamic monitoring in the critically ill: An overview of current cardiac output monitoring methods. https://doi.org/10.12688/f1000research.8991.1
Kiefer, N., Hofer, C. K., Marx, G., Geisen, M., Giraud, R., Siegenthaler, N., Hoeft, A., Bendjelid, K., & Rex, S. (2012). Clinical validation of a new thermodilution system for the assessment of cardiac output and volumetric parameters. Critical Care, 16(3). https://doi.org/10.1186/cc11366
Litton, E., & Morgan, M. (2012). The PiCCO monitor: A review. https://doi.org/10.1177/0310057x1204000304
Lopes, M. R., Oliveira, M. A., Pereira, V. O. S., Lemos, I. P. B., Júnior, J. O. C. A., & Michard, F. (2007). Goal-directed fluid management based on PULSE pressure variation monitoring during high-risk surgery: A pilot randomized controlled trial. Critical Care, 11(5). https://doi.org/10.1186/cc6117
Monnet, X., & Teboul, J. (2017). Transpulmonary thermodilution: Advantages and limits. Critical Care, 21(1), 147–147. https://doi.org/10.1186/s13054-017-1739-5
Muzaffar, S. N., Pradhan, A., Siddiqui, S. S., Roy, S., & Suresh, T. (2023). Monitoring macro- and microcirculation in the critically ill: A narrative review. https://doi.org/10.1055/s-0043-1772175
Ritter, S., Rudiger, A., & Maggiorini, M. (2009). Transpulmonary thermodilution-derived cardiac function index identifies cardiac dysfunction in acute heart failure and septic patients: An observational study. Critical Care, 13(4). https://doi.org/10.1186/cc7994
DL, T. (2008). 21st ESICM annual congress. Intensive Care Medicine, 34. https://doi.org/10.1007/s00134-008-1239-9
Sakka, S., Bruecken, U., Gloeckner, U., & Wappler, F. (2009). Influence of prone positioning on measurement of extravascular lung water and pulmonary vascular permeability indexes by transpulmonary thermodilution. Critical Care, 13. https://doi.org/10.1186/cc7388
Sánchez, J. I. A., Ruiz, J. D. C., Fernández, J. J. D., Zúñiga, W. F. A., Tascón, G. A., & Martínez, L. (2021). Predictors of fluid responsiveness in critically ill patients mechanically ventilated at low tidal volumes: Systematic review and meta-analysis. Annals of Intensive Care, 11(1), 28–28. https://doi.org/10.1186/s13613-021-00817-5
Tagami, T., Nakamura, T., Kushimoto, S., Tosa, R., Watanabe, A., Kaneko, T., Fukushima, H., Rinka, H., Kudo, D., Uzu, H., Murai, A., Takatori, M., Izumino, H., Kase, Y., Seo, R., Takahashi, H., Kitazawa, Y., Yamaguchi, J., Sugita, M., & Yokota, H. (2014). Early-phase changes of extravascular lung water index as a prognostic indicator in acute respiratory distress syndrome patients. Annals of Intensive Care, 4(1), 27–27. https://doi.org/10.1186/s13613-014-0027-7
Takala, J., Ruokonen, E., Tenhunen, J., Parviainen, I., & Jakob, S. M. (2011). Early non-invasive cardiac output monitoring in hemodynamically unstable intensive care patients: A multi-center randomized controlled trial. Critical Care, 15(3). https://doi.org/10.1186/cc10273
Uchino, S., Bellomo, R., Morimatsu, H., Sugihara, M., French, C., Stephens, D., Wendon, J., Honoré, P. M., Mulder, J., & Turner, A. (2006). Pulmonary artery catheter versus PULSE contour analysis: A prospective epidemiological study. Critical Care, 10(6). https://doi.org/10.1186/cc5126
Wang, H., Cui, N., Su, L., Long, Y., Wang, X., Zhou, X., Chai, W., & Liu, D. (2016). Prognostic value of extravascular lung water and its potential role in guiding fluid therapy in septic shock after initial resuscitation. Journal of Critical Care, 33, 106–113. https://doi.org/10.1016/j.jcrc.2016.02.011
Yuanbo, Z., Wang, J., Shi, F., Long, L., Liu, X., Xu, S., & Shan, A. (2016). ICU management based on PiCCO parameters reduces duration of mechanical ventilation and ICU length of stay in patients with severe thoracic trauma and acute respiratory distress syndrome. Annals of Intensive Care, 6(1), 113–113. https://doi.org/10.1186/s13613-016-0217-6
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