ICU · Monitoring / haemodynamics

Advanced Haemodynamic Monitoring — PA Catheter, PiCCO & Pulse Contour

Also known as Advanced haemodynamic monitoring · Pulmonary artery catheter · PAC · Swan-Ganz · PiCCO · Transpulmonary thermodilution · Pulse contour analysis · FloTrac · Vigileo · LiDCO · Esophageal Doppler · Extravascular lung water · EVLW · GEDI · ITBI · Mixed venous oxygen saturation · SvO2 · LVOT VTI

Advanced haemodynamic monitoring measures the cardiac output and related variables beyond the basic arterial and CVP lines. The pulmonary artery catheter (PAC, Swan-Ganz) is the gold standard — it directly measures the PAWP (left atrial pressure), the SvO2 (oxygen balance), and the CO by thermodilution, but its routine use has declined after the FACTT trial (no benefit over central-line-guided therapy); it is now reserved for complex shock, pulmonary hypertension, and RV failure. The PiCCO (transpulmonary thermodilution) provides the CO, the GEDV (preload), the EVLW (lung water), and a calibrated continuous pulse-contour CO and SVV. Uncalibrated pulse contour devices (FloTrac/Vigileo) use an arterial line alone and are less accurate; LiDCO (lithium dilution) is a calibrated alternative needing only a radial line; esophageal Doppler gives continuous CO from the descending aorta. Echocardiography (LVOT VTI) is the leading non-invasive alternative. The choice depends on the clinical question: filling pressure (PAWP), volume (GEDV), responsiveness (SVV/PPV), or oxygen balance (SvO2).