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
Several articles are attached regarding volume management, revoiew of clinical parameters, as well as still a small role for CVP ( as long as the physiology of what CVP means is understood)monitoring, and critical role echocardiography appears to play in early management of septic shock .
Articles:
1) Alternatives to the Swan -Ganz Catheter
2) Expert Statement for the Management of Hypovolemia in Sepsis
3) Should we measure the CVP to guide fluid management: Ten answers to 10 questions
4) TTE and Mortality in Sepsis
5) Lactate Guided ResuscitationSaves Lives: no ( Editorial)
Please see my next entry in this blog for an extended discussion and the problems with lactate guided therapy in sepsis.
Links to Noninvasive and Minimally Invasive Devices mentioned in the above articles
ClearSight system
Flotrac on EV1000 clinical platform
EV1000 Brochure
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