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Intensive Care Medicine

, Volume 44, Issue 6, pp 730–741 | Cite as

Alternatives to the Swan–Ganz catheter

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

Abstract

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.

Keywords

Hemodynamic monitoring Cardiac output Tissue perfusion Cardiac failure 

Notes

Compliance with ethical standards

Conflicts of interest

Daniel De Backer: Consultant to and given material for studies by Edwards Lifesciences. Jan Bakker: No conflict of interest. Maurizio Cecconi: No conflict of interest. Ludhmila Hajjar: No conflict of interest. Da-Wei Liu: No conflict of interest. Suzana Margareth Lobo: No conflict of interest. Xavier Monnet: Consultant to Pulsion/GETINGE, Munich, Germany. Andrea Morelli: No conflict of interest. Sheila Nainan Myatra: No conflict of interest. Azriel Perel: Consultant to Pulsion/GETINGE, Munich, Germany, and to Masimo Inc., Irvine, CA, USA. Michael R. Pinsky: Consultant to Edwards Lifesciences, Cheetah Medical, LiDCO Ltd., honoraria for lectures from Masimo Inc., Edwards LifeSciences, Cheetah Medical, and stock options with LiDCO Ltd., Cheetah Medical. Bernd Saugel: Collaboration with Pulsion Medical Systems SE (Feldkirchen, Germany) as a member of the medical advisory board and received honoraria for lectures and refunds of travel expenses from Pulsion Medical Systems SE. BS received institutional research grants, unrestricted research grants, and refunds of travel expenses from Tensys Medical Inc. (San Diego, CA, USA). BS received honoraria for lectures and refunds of travel expenses from CNSystems Medizintechnik AG (Graz, Austria). BS received research support from Edwards Lifesciences (Irvine, CA, USA). Jean-Louis Teboul: Consultant to Pulsion/GETINGE, Munich, Germany. Antoine Vieillard-Baron: Received a grant from GSK for conducting clinical research and is a member of its scientific advisory board. Jean Louis Vincent: No conflict of interest.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature and ESICM 2018

Authors and Affiliations

  • Daniel De Backer
    • 1
    Email author
  • Jan Bakker
    • 2
    • 3
    • 4
  • Maurizio Cecconi
    • 5
  • Ludhmila Hajjar
    • 6
  • Da Wei Liu
    • 7
  • Suzanna Lobo
    • 8
  • Xavier Monnet
    • 9
  • Andrea Morelli
    • 10
  • Sheila Neinan Myatra
    • 11
  • Azriel Perel
    • 12
  • Michael R. Pinsky
    • 13
  • Bernd Saugel
    • 14
  • Jean-Louis Teboul
    • 9
  • Antoine Vieillard-Baron
    • 15
    • 16
  • Jean-Louis Vincent
    • 17
  1. 1.Department of Intensive Care, CHIREC HospitalsUniversité Libre de BruxellesBrusselsBelgium
  2. 2.Department of Intensive Care AdultsErasmus MC University HospitalRotterdamThe Netherlands
  3. 3.Department of Pulmonology and Critical CareNew York University Medical CenterNew YorkUSA
  4. 4.Department of Pulmonology and Critical CareColumbia University Medical CenterNew YorkUSA
  5. 5.Department Anaesthesia and Intensive Care UnitsIRCCS Istituto Clinico Humanitas, Humanitas UniversityMilanItaly
  6. 6.Department of Cardiopneumology, Heart InstituteUniversity of Sao PauloSao PauloBrazil
  7. 7.Department of Critical Care MedicinePeking Union Medical College HospitalBeijingChina
  8. 8.Intensive Care Division, Medical School, FAMERPHospital de Base de São José Rio PretoSão José do Rio PretoBrazil
  9. 9.Medical Intensive Care Unit, Bicetre Hospital, Paris-Sud University Hospitals Inserm UMR_S999Paris-Sud UniversityLe Kremlin-BicetreFrance
  10. 10.Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric SciencesUniversity of Rome “La Sapienza”RomeItaly
  11. 11.Department of Anaesthesiology, Critical Care and PainTata Memorial HospitalMumbaiIndia
  12. 12.Department of Anesthesiology and Intensive Care, Sheba Medical CenterTel Aviv UniversityTel AvivIsrael
  13. 13.Department of Critical Care MedicineUniversity of PittsburghPittsburghUSA
  14. 14.Center of Anesthesiology and Intensive Care Medicine, Department of AnesthesiologyUniversity Medical Center Hamburg-EppendorfHamburgGermany
  15. 15.Assistance Publique-Hôpitaux de ParisUniversity Hospital Ambroise Paré Intensive Care UnitBoulogne-BillancourtFrance
  16. 16.INSERM U-1018, CESP, Team 5University of Versailles Saint-Quentin en YvelinesVillejuifFrance
  17. 17.Department of Intensive Care, Erasme University HospitalUniversité Libre de BruxellesBrusselsBelgium

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