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

Area of Science:

• Critical Care Medicine
• Cardiovascular Physiology
• Medical Technology

Background:

• The pulmonary artery catheter (PAC) has been pivotal in assessing hemodynamic parameters like preload, afterload, and contractility.
• Its placement involves a percutaneous, flow-directed, balloon-tipped technique through the venous system into the pulmonary artery.
• Advancements in hemodynamic monitoring have led to the development of less-invasive alternatives over the last three decades.

Purpose of the Study:

• To review the historical development, technological advancements, and current applications of PACs.
• To critically evaluate the clinical utility, reliability, and safety concerns associated with PACs.
• To discuss the benefits and limitations of alternative hemodynamic monitoring devices for critically ill patients.

Main Methods:

• Review of the conception, technological evolution, and modern utilization of PACs.
• Analysis of criticisms regarding PACs' clinical utility, reliability, and safety.
• Evaluation of current understanding of alternative hemodynamic monitors' benefits and limitations.
• Brief discussion on hemodynamic monitoring within Enhanced Recovery After Surgery (ERAS) protocols.

Main Results:

• PACs provide essential bedside hemodynamic assessment, guiding critical care decisions.
• Numerous less-invasive hemodynamic monitoring technologies have emerged, estimating cardiac output through various principles.
• Ongoing debate exists regarding the clinical utility, reliability, and safety of PACs.
• Understanding alternative monitors is crucial for managing critically ill patients.

Conclusions:

• PACs remain a significant tool for hemodynamic assessment, despite ongoing debates.
• Alternative less-invasive monitors offer valuable insights into hemodynamic status.
• Hemodynamic monitoring plays a role in optimizing fluid therapy within ERAS programs.