Esophageal Doppler ultrasound monitor versus pulmonary artery catheter in the hemodynamic management of critically ill surgical patients.
BACKGROUND
The pulmonary artery (PA) catheter has been used to determine hemodynamic indices; however, it has recently been criticized. This study was undertaken to evaluate an esophageal Doppler monitor (EDM) as a possible replacement for PA catheter in critically ill, mechanically ventilated patients.


METHODS
EDM and PA catheters were placed in patients in the surgical intensive care units (n = 14, 118 matched sets of data). PA catheter and EDM measurements, including corrected flow time (FTc,) a measure of preload, were obtained. Pearson correlation (r) was analyzed to compare PA catheter and EDM measurements, and a nonlinear regression model was used to describe Starling Relationships.


RESULTS
Cardiac output correlated between EDM and PA catheter (r = 0.6; p < 0.001). FTc correlated more strongly with cardiac output than did pulmonary capillary wedge pressure. (FTc: r2 = 0.27; p < 0.001; cardiac output: r2 = 0.04; p = 0.06).


CONCLUSIONS
Corrected flow time is a better indicator of preload than pulmonary capillary wedge pressures. EDM seems to be at least as useful as PA catheter in managing the hemodynamic status of critically ill surgical patients.
Madan
A K
AK
Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA.
UyBarreta
V V
VV
Aliabadi-Wahle
S
S
Jesperson
R
R
Hartz
R S
RS
Flint
L M
LM
Steinberg
S M
SM
D000328:Adult; D000368:Aged; D002407:Catheterization, Swan-Ganz; D003422:Critical Care; D016638:Critical Illness / Q000628:therapy*; D004947:Esophagus / Q000000981:diagnostic imaging*; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D011183:Postoperative Complications; D014463:Ultrasonography