To Swan or Not to Swan: Indications, Alternatives, and Future Directions

The pulmonary artery catheter (PAC) has revolutionized bedside assessment of preload, afterload, and contractility using measured pulmonary capillary wedge pressure, calculated systemic vascular resistance, and estimated cardiac output. It is placed percutaneously by a flow-directed balloon-tipped t...

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Bibliographic Details
Published in:Journal of cardiothoracic and vascular anesthesia 2021-02, Vol.35 (2), p.600-615
Main Authors: Rozental, Olga, Thalappillil, Richard, White, Robert S., Tam, Christopher W.
Format: Article
Language:English
Subjects:
Animals
Anseriformes
Cardiac Output
cardiac output (CO)
Catheterization, Swan-Ganz
Enhanced Recovery After Surgery (ERAS)
hemodynamic monitoring
Hemodynamics
Humans
pulmonary artery catheter (PAC)
pulmonary capillary wedge pressure (PCWP)
Reproducibility of Results
Thermodilution
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Summary:The pulmonary artery catheter (PAC) has revolutionized bedside assessment of preload, afterload, and contractility using measured pulmonary capillary wedge pressure, calculated systemic vascular resistance, and estimated cardiac output. It is placed percutaneously by a flow-directed balloon-tipped technique through the venous system and the right heart to the pulmonary artery. Interest in the hemodynamic variables obtained from PACs paved the way for the development of numerous less-invasive hemodynamic monitors over the past 3 decades. These devices estimate cardiac output using concepts such as pulse contour and pressure analysis, transpulmonary thermodilution, carbon dioxide rebreathing, impedance plethysmography, Doppler ultrasonography, and echocardiography. Herein, the authors review the conception, technologic advancements, and modern use of PACs, as well as the criticisms regarding the clinical utility, reliability, and safety of PACs. The authors comment on the current understanding of the benefits and limitations of alternative hemodynamic monitors, which is important for providers caring for critically ill patients. The authors also briefly discuss the use of hemodynamic monitoring in goal-directed fluid therapy algorithms in Enhanced Recovery After Surgery programs.
ISSN:1053-0770
1532-8422
DOI:10.1053/j.jvca.2020.07.067