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Pulmonary Artery Catheterization and Esophageal Doppler Monitoring in the ICU^*

^* From the Department of Internal Medicine, Section of Critical Care, Director, Medical Intensive Care Unit, Washington Hospital Center, Washington, DC.

Correspondence to: Paul E. Marik, MD, FCCP, Department of Internal Medicine, Washington Hospital Center, 110 Irving St, NW, Washington, DC 20010-2975; e-mail: pem4{at}mhg.edu

The clinical assessment of cardiac performance and ventricular preload is notoriously unreliable in critically ill patients. Consequently, a number of technologies have been developed to provide the clinician with indexes of cardiovascular function to assist in therapeutic decision making. Foremost among these is the pulmonary artery catheter (PAC). Indeed, the PAC has largely shaped the practice of modern critical care. Yet, the information provided by the PAC is largely misunderstood, and its efficacy is never proven. Recently, continuous esophageal Doppler monitoring has emerged as an alternative to pulmonary artery catheterization. This paper evaluates the clinical utility of the PAC and esophageal Doppler monitoring in assessing the hemodynamic status of ICU patients.

Key Words: cardiac function • esophageal Doppler • ICU • pulmonary artery catheter • pulmonary artery occlusion pressure • right ventricular end-diastolic volume index

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