2018 Articles

Alternatives to the Swan-Ganz catheter

De Backer, Daniel; Bakker, Jan; Cecconi, Maurizio; Hajjar, Ludhmila; Liu, Da Wei; Lobo, Suzanna; Monnet, Xavier; Morelli, Andrea; Myatra, Sheila Neinan; Perel, Azriel; Pinsky, Michael R.; Saugel, Bernd; Teboul, Jean-Louis; Vieillard-Baron, Antoine; Vincent, Jean-Louis

While the pulmonary artery catheter (PAC) is still interesting in specific situations, there are many alternatives. A group of experts from different backgrounds discusses their respective interests and limitations of the various techniques and related measured variables. The goal of this review is to highlight the conditions in which the alternative devices will suffice and when they will not or when these alternative techniques can provide information not available with PAC. The panel concluded that it is useful to combine different techniques instead of relying on a single one and to adapt the "package" of interventions to the condition of the patient. As a first step, the clinical and biologic signs should be used to identify patients with impaired tissue perfusion. Whenever available, echocardiography should be performed as it provides a rapid and comprehensive hemodynamic evaluation. If the patient responds rapidly to therapy, either no additional monitoring or pulse wave analysis (allowing continuous monitoring in case potential degradation is anticipated) can be applied. If the patient does not rapidly respond to therapy or complex hemodynamic alterations are observed, pulse wave analysis coupled with TPTD is suggested.