Replacing the pulmonary artery catheter by less invasive monitoring. Are we ready yet?

The goal of hemodynamic monitoring is to identify cardiovascular pathology, monitor resuscitation and determine when recovery has been achieved. The pulmonary artery catheter (PAC) has been used for over 40 years to accomplish those goals. PAC specific measures include cardiac output, intrathoracic vascular pressures and mixed venous O2 saturation (SvO2). Although newer less invasive\ud devices are now available to monitor specific components of the profile given by the PAC, none can accurately estimate SvO2 or pulmonary arterial or venous pressures (as pulmonary artery occlusion pressure). However, cardiac output can be easily measured by many other devices including arterial wave form monitors and esophageal Doppler catheters and transthoracic echocardiography. To the extent that data useful for diagnosis and/or management can be made by these less invasive means, then the PAC should not be used. But in those settings where accurate measures of SvO2 and pulmonary vascular pressures are needed, the PAC is the only device that can do the job