LAUSR

Swan–Ganz catheter use in the intensive care unit (ICU) is an endless matter of debate. In the past decade echocardiography has emerged as a major tool for understanding mechanisms of shock. We do not deny the utmost importance of echocardiography in the early phase of management of patients with shock. However, the use of echocardiography as a monitoring device is highly time consuming and operator dependent. For these reasons, we exclude echocardiography from this pro/con debate. As experts have no clear-cut opinion between Swan– Ganz catheter versus transpulmonary thermodilution for the diagnosis and monitoring of patients with shock states, we will review and defend Swan–Ganz catheter advantages. Modern hemodynamics approach in ICU relies on theoretical concepts that have been validated through heart catheterization. The Swan–Ganz catheter was the first device to make possible the application of heart catheterization at the bedside [1] and allowed us to build our common knowledge of systemic, as well as pulmonary hemodynamics. For these historical reasons, Swan–Ganz catheters represent a key pedagogical tool for teaching, learning and understanding hemodynamics and shock pathophysiology [2]. Moreover, in patients with acute respiratory distress syndrome (ARDS), it provides meaningful information for correct interpretation of gas exchange [3]. Swan–Ganz catheter provides measurements of right and left ventricular preloads by the direct measurement of pressures (central venous pressure, right atrial pressure, pulmonary artery pressure and pulmonary artery occlusion pressure), as well as cardiac output (using thermodilution principle, a robust technique) and mixed venous oxyhemoglobin saturation (SvO2). The Swan– Ganz catheter allows calculation of important metabolic variables such as oxygen delivery, consumption and extraction. Furthermore, it allows estimation of vasomotor tone through pulmonary and systemic vascular resistance indexes. The most recent version of Swan–Ganz catheters with continuous cardiac output and SvO2 monitoring are especially appreciated in patients with low cardiac output. Of note, Swan–Ganz catheters without these automatic and continuous monitoring options are less adequate for early warning. Despite the development of other monitoring tools in the ICU, the Swan–Ganz catheter is the only device offering the possibility to assess easily and monitor continuously right ventricle function [4]. This is helpful to diagnose right ventricle failure in everyday life, which is reflected by increased right atrial pressure and decreased