Is there still a place for the Swan‒Ganz catheter? We are not sure

Excerpt

The pulmonary artery catheter (PAC) was introduced in clinical practice in the 1970s [1]. The PAC provides a unique and comprehensive evaluation of the cardiovascular status of the critically ill, with measurements of cardiac output and its determinants. In addition, it provides information on the adequacy of cardiac output by measurements of mixed-venous oxygen saturation (SvO₂) and on left heart function through pulmonary artery occlusion pressure and right heart function with the measurement of pulmonary arterial pressure (PAP), right ventricular ejection fraction, and central venous pressure (CVP). Its use peaked in the 1980s; however, the publication of studies suggesting potential harm resulted in a steady decrease in its use. By the start of the new millennium, PAC use had markedly decreased even more [2], so that one could even predict its disappearance. Recent data suggest a revival in PAC [3‐5]. The reasons for this revival are multiple. First, multiple randomized trials have shown that PAC does not increase the risk of death [6]. In high-risk patients, PAC may even improve mortality [7]. Second, the alternative techniques, which have markedly increased in options, do not always have enough reliability and, more importantly, do not always provide all the information provided by PAC. In the view of the authors who frequently use PAC and the alternative methods, the use of PAC and of the other methods should be based on the patient condition and the potential gain that can be gathered from the measured variables [8]. This attitude, in line with current guidelines [9, 10], will be discussed in this editorial. We will focus on PAC, echocardiography, and pulse wave analysis coupled with transpulmonary thermodilution (TPTD) which provide the same level of information. …