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Alternatives to the Swan–Ganz catheter

Daniel De Backer| Jan Bakker| Maurizio Cecconi| Ludhmila Hajjar| Da Wei Liu| Suzanna Lobo| Xavier Monnet| Andrea Morelli| Sheila Neinan Myatra| Azriel Perel| Michael R. Pinsky| Bernd Saugel| Jean-Louis Teboul| Antoine Vieillard-Baron| Jean-Louis Vincent
Review
Volume 44, Issue 6 / June , 2018

Pages 730 - 741

Abstract

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.

Keywords

References

  1. The Nobel Prize in Physiology or Medicine 1956. 2014. Nobelprize.org <http://www.nobelprize.org/nobel_prizes/medicine/laureates/1956/>. Accessed 8-4-2018 (Online Source)
  2. Swan HJ, Ganz W, Forrester J, Marcus H, Diamond G, Chonette D (1970) Catheterization of the heart in man with use of a flow-directed balloon-tipped catheter. N Engl J Med 283:447–451
    • View reference on publisher's website
  3. Ganz W, Donoso R, Marcus HS, Forrester JS, Swan HJ (1971) A new technique for measurement of cardiac output by thermodilution in man. Am J Cardiol 27:392–396
    • View reference on publisher's website
  4. Shoemaker WC, Appel PL, Kram HB, Waxman K, Lee T-S (1988) Prospective trial of supranormal values of survivors as therapeutic goals in high-risk surgical patients. Chest 94:1176–1186
    • View reference on publisher's website
  5. Connors AF, Speroff T, Dawson NV, Thomas C, Harrell FE, Wagner D et al (1996) The effectiveness of right heart catheterization in the initial care of critically ill patients. JAMA 276:889–897
    • View reference on publisher's website
  6. Richard C, Warszawski J, Anguel N, Deye N, Combes A, Barnoud D et al (2003) Early use of the pulmonary artery catheter and outcomes in patients with shock and acute respiratory distress syndrome: a randomized controlled trial. JAMA 290:2713–2720
    • View reference on publisher's website
  7. Shah MR, Hasselblad V, Stevenson LW, Binanay C, O’Connor CM, Sopko G et al (2005) Impact of the pulmonary artery catheter in critically ill patients: meta-analysis of randomized clinical trials. JAMA 294:1664–1670
    • View reference on publisher's website
  8. Sotomi Y, Sato N, Kajimoto K, Sakata Y, Mizuno M, Minami Y et al (2014) Impact of pulmonary artery catheter on outcome in patients with acute heart failure syndromes with hypotension or receiving inotropes: from the ATTEND Registry. Int J Cardiol 172:165–172
    • View reference on publisher's website
  9. Friese RS, Shafi S, Gentilello LM (2006) Pulmonary artery catheter use is associated with reduced mortality in severely injured patients: a national trauma data bank analysis of 53,312 patients. Crit Care Med 34:1597–1601
    • View reference on publisher's website
  10. Pinsky MR, Vincent JL (2005) Let us use the pulmonary artery catheter correctly and only when we need it. Crit Care Med 33:1119–1122
    • View reference on publisher's website
  11. Vincent JL, Rhodes A, Perel A, Martin GS, Della RG, Vallet B et al (2011) Clinical review: update on hemodynamic monitoring—a consensus of 16. Crit Care 15:229
    • View reference on publisher's website
  12. De Backer D, Fagnoul D, Herpain A (2013) The role of invasive techniques in cardiopulmonary evaluation. Curr Opin Crit Care 19:228–233
    • View reference on publisher's website
  13. Cecconi M, De Backer D, Antonelli M, Beale RJ, Bakker J, Hofer C et al (2014) Consensus on circulatory shock and hemodynamic monitoring. Task Force of the European Society of Intensive Care Medicine. Intensive Care Med 40:1795–1815
  14. Teboul JL, Saugel B, Cecconi M, De Backer D, Hofer CK, Monnet X et al (2016) Less invasive hemodynamic monitoring in critically ill patients. Intensive Care Med 42:1350–1359
  15. Vincent JL, De Backer D (2013) Circulatory shock. N Engl J Med 369:1726–1734
    • View reference on publisher's website
  16. Ait-Oufella H, Bakker J (2016) Understanding clinical signs of poor tissue perfusion during septic shock. Intensive Care Med 42:2070–2072
  17. Joly HR, Weil MH (1969) Temperature of the great toe as an indication of the severity of shock. Circulation 39:131–138
    • View reference on publisher's website
  18. van Genderen ME, Engels N, van der Valk RJ, Lima A, Klijn E, Bakker J et al (2015) Early peripheral perfusion-guided fluid therapy in patients with septic shock. Am J Respir Crit Care Med 191:477–480
    • View reference on publisher's website
  19. Lima A, Jansen TC, van Bommel J, Ince C, Bakker J (2009) The prognostic value of the subjective assessment of peripheral perfusion in critically ill patients. Crit Care Med 37:934–938
    • View reference on publisher's website
  20. Lima A, van Bommel J, Sikorska K, van Genderen M, Klijn E, Lesaffre E et al (2011) The relation of near-infrared spectroscopy with changes in peripheral circulation in critically ill patients. Crit Care Med 39:1649–1654
    • View reference on publisher's website
  21. Oskay A, Eray O, Dinc SE, Aydin AG, Eken C (2015) Prognosis of critically ill patients in the ED and value of perfusion index measurement: a cross-sectional study. Am J Emerg Med 33:1042–1044
    • View reference on publisher's website
  22. He HW, Liu DW, Long Y, Wang XT (2013) The peripheral perfusion index and transcutaneous oxygen challenge test are predictive of mortality in septic patients after resuscitation. Crit Care 17:R116
    • View reference on publisher's website
  23. Ait-Oufella H, Lemoinne S, Boelle PY, Galbois A, Baudel JL, Lemant J et al (2011) Mottling score predicts survival in septic shock. Intensive Care Med 37:801–807
  24. Coudroy R, Jamet A, Frat JP, Veinstein A, Chatellier D, Goudet V et al (2015) Incidence and impact of skin mottling over the knee and its duration on outcome in critically ill patients. Intensive Care Med 41:452–459
  25. Ait-Oufella H, Joffre J, Boelle PY, Galbois A, Bourcier S, Baudel JL et al (2012) Knee area tissue oxygen saturation is predictive of 14-day mortality in septic shock. Intensive Care Med 38:976–983
  26. Ait-Oufella H, Bige N, Boelle PY, Pichereau C, Alves M, Bertinchamp R et al (2014) Capillary refill time exploration during septic shock. Intensive Care Med 40:958–964
  27. Brunauer A, Kokofer A, Bataar O, Gradwohl-Matis I, Dankl D, Bakker J et al (2016) Changes in peripheral perfusion relate to visceral organ perfusion in early septic shock: a pilot study. J Crit Care 35:105–109
    • View reference on publisher's website
  28. Boerma EC, Kuiper MA, Kingma WP, Egbers PH, Gerritsen RT, Ince C (2008) Disparity between skin perfusion and sublingual microcirculatory alterations in severe sepsis and septic shock: a prospective observational study. Intensive Care Med 34:1294–1298
  29. Lima A, van Genderen ME, van Bommel J, Klijn E, Jansem T, Bakker J (2014) Nitroglycerin reverts clinical manifestations of poor peripheral perfusion in patients with circulatory shock. Crit Care 18:R126
    • View reference on publisher's website
  30. De Backer D, Creteur J, Noordally O, Smail N, Gulbis B, Vincent JL (1998) Does hepato-splanchnic VO2/DO2 dependency exist in critically ill septic patients? Am J Respir Crit Care Med 157:1219–1225
    • View reference on publisher's website
  31. Reinhart K, Kuhn HJ, Hartog C, Bredle DL (2004) Continuous central venous and pulmonary artery oxygen saturation monitoring in the critically ill. Intensive Care Med 30:1572–1578
  32. Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R et al (2017) Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016. Intensive Care Med 43:304–377
  33. Levy B, Gibot S, Franck P, Cravoisy A, Bollaert PE (2005) Relation between muscle Na + K + ATPase activity and raised lactate concentrations in septic shock: a prospective study. Lancet 365:871–875
    • View reference on publisher's website
  34. Ospina-Tascon GA, Umana M, Bermudez WF, Bautista-Rincon DF, Valencia JD, Madrinan HJ et al (2016) Can venous-to-arterial carbon dioxide differences reflect microcirculatory alterations in patients with septic shock? Intensive Care Med 42:211–221
  35. Perner A, Gordon AC, De Backer D, Dimopoulos G, Russell JA, Lipman J et al (2016) Sepsis: frontiers in diagnosis, resuscitation and antibiotic therapy. Intensive Care Med 42:1958–1969
  36. Pinsky M, Vincent JL, De Smet JM (1991) Estimating left ventricular filling pressure during positive end-expiratory pressure in humans. Am Rev Respir Dis 143:25–31
    • View reference on publisher's website
  37. De Backer D, Vincent JL (2018) Should we measure the central venous pressure to guide fluid management? Ten answers to 10 questions. Crit Care 22:43
    • View reference on publisher's website
  38. Hadian M, Kim HK, Severyn DA, Pinsky MR (2010) Cross-comparison of cardiac output trending accuracy of LiDCO, PiCCO, FloTrac and pulmonary artery catheters. Crit Care 14:R212
    • View reference on publisher's website
  39. Hamzaoui O, Monnet X, Richard C, Osman D, Chemla D, Teboul JL (2008) Effects of changes in vascular tone on the agreement between pulse contour and transpulmonary thermodilution cardiac output measurements within an up to 6-hour calibration-free period. Crit Care Med 36:434–440
    • View reference on publisher's website
  40. Joosten A, Desebbe O, Suehiro K, Murphy LS, Essiet M, Alexander B et al (2017) Accuracy and precision of non-invasive cardiac output monitoring devices in perioperative medicine: a systematic review and meta-analysisdagger. Br J Anaesth 118:298–310
    • View reference on publisher's website
  41. Peyton PJ, Chong SW (2010) Minimally invasive measurement of cardiac output during surgery and critical care: a meta-analysis of accuracy and precision. Anesthesiology 113:1220–1235
    • View reference on publisher's website
  42. Sakka SG, Kozieras J, Thuemer O, van Hout N (2007) Measurement of cardiac output: a comparison between transpulmonary thermodilution and uncalibrated pulse contour analysis. Br J Anaesth 99:337–342
    • View reference on publisher's website
  43. Scolletta S, Franchi F, Romagnoli S, Carla R, Donati A, Fabbri LP et al (2016) Comparison between Doppler-Echocardiography and uncalibrated pulse contour method for cardiac output measurement: a multicenter observational study. Crit Care Med 44:1370–1379
    • View reference on publisher's website
  44. De Backer D, Marx G, Tan A, Junker C, Van NM, Huter L et al (2011) Arterial pressure-based cardiac output monitoring: a multicenter validation of the third-generation software in septic patients. Intensive Care Med 37:233–240
  45. Meng L, Phuong TN, Alexander BS, Laning K, Chen G, Kain ZN et al (2011) The impact of phenylephrine, ephedrine, and increased preload on third-generation Vigileo-FLOTRAC and esophageal Doppler cardiac output measurements. Anesth Analg 113:751–757
    • View reference on publisher's website
  46. Monnet X, Teboul JL (2017) Transpulmonary thermodilution: advantages and limits. Crit Care 21:147
    • View reference on publisher's website
  47. Monnet X, Anguel N, Osman D, Hamzaoui O, Richard C, Teboul JL (2007) Assessing pulmonary permeability by transpulmonary thermodilution allows differentiation of hydrostatic pulmonary edema from ALI/ARDS. Intensive Care Med 33:448–453
  48. Vignon P, Begot E, Mari A, Silva S, Chimot L, Delour P et al (2018) Hemodynamic assessment of patients with septic shock using transpulmonary thermodilution and critical care echocardiography: a comparative study. Chest 153:55–64
    • View reference on publisher's website
  49. Perel A, Saugel B, Teboul JL, Malbrain ML, Belda FJ, Fernandez-Mondejar E et al (2016) The effects of advanced monitoring on hemodynamic management in critically ill patients: a pre and post questionnaire study. J Clin Monit Comput 30:511–518
    • View reference on publisher's website
  50. Ritter S, Rudiger A, Maggiorini M (2009) Transpulmonary thermodilution-derived cardiac function index identifies cardiac dysfunction in acute heart failure and septic patients: an observational study. Crit Care 13:R133
    • View reference on publisher's website
  51. Hilty MP, Franzen DP, Wyss C, Biaggi P, Maggiorini M (2017) Validation of transpulmonary thermodilution variables in hemodynamically stable patients with heart diseases. Ann Intensive Care 7:86
    • View reference on publisher's website
  52. Belda FJ, Aguilar G, Teboul JL, Pestana D, Redondo FJ, Malbrain M et al (2011) Complications related to less-invasive haemodynamic monitoring. Br J Anaesth 106:482–486
    • View reference on publisher's website
  53. Uchino S, Bellomo R, Morimatsu H, Sugihara M, French C, Stephens D et al (2006) Pulmonary artery catheter versus pulse contour analysis: a prospective epidemiological study. Crit Care 10:R174
    • View reference on publisher's website
  54. Trof RJ, Beishuizen A, Cornet AD, de Wit RJ, Girbes AR, Groeneveld AB (2012) Volume-limited versus pressure-limited hemodynamic management in septic and nonseptic shock. Crit Care Med 40:1177–1185
    • View reference on publisher's website
  55. Papolos A, Narula J, Bavishi C, Chaudhry FA, Sengupta PP (2016) U.S. Hospital use of echocardiography: insights from the Nationwide Inpatient Sample. J Am Coll Cardiol 67:502–511
    • View reference on publisher's website
  56. Wetterslev M, Moller-Sorensen H, Johansen RR, Perner A (2016) Systematic review of cardiac output measurements by echocardiography vs. thermodilution: the techniques are not interchangeable. Intensive Care Med 42:1223–1233
  57. Mercado P, Maizel J, Beyls C, Titeca-Beauport D, Joris M, Kontar L et al (2017) Transthoracic echocardiography: an accurate and precise method for estimating cardiac output in the critically ill patient. Crit Care 21:136
    • View reference on publisher's website
  58. Huttemann E, Schelenz C, Kara F, Chatzinikolaou K, Reinhart K (2004) The use and safety of transoesophageal echocardiography in the general ICU—a minireview. Acta Anaesthesiol Scand 48:827–836
    • View reference on publisher's website
  59. Mayo PH, Beaulieu Y, Doelken P, Feller-Kopman D, Harrod C, Kaplan A et al (2009) American College of Chest Physicians/La Societe de Reanimation de Langue Francaise statement on competence in critical care ultrasonography. Chest 135:1050–1060
    • View reference on publisher's website
  60. Vieillard-Baron A, Chergui K, Augarde R, Prin S, Page B, Beauchet A et al (2003) Cyclic changes in arterial pulse during respiratory support revisited by Doppler echocardiography. Am J Respir Crit Care Med 168:671–676
    • View reference on publisher's website
  61. Vieillard-Baron A, Matthay M, Teboul JL, Bein T, Schultz M, Magder S et al (2016) Experts’ opinion on management of hemodynamics in ARDS patients: focus on the effects of mechanical ventilation. Intensive Care Med 42:739–749
  62. Vignon P, Repesse X, Begot E, Leger J, Jacob C, Bouferrache K et al (2016) Comparison of echocardiographic indices used to predict fluid responsiveness in ventilated patients. Am J Respir Crit Care Med 195:1022–1032
    • View reference on publisher's website
  63. Papanikolaou J, Makris D, Saranteas T, Karakitsos D, Zintzaras E, Karabinis A et al (2011) New insights into weaning from mechanical ventilation: left ventricular diastolic dysfunction is a key player. Intensive Care Med 37:1976–1985
  64. Sanfilippo F, Corredor C, Arcadipane A, Landesberg G, Vieillard-Baron A, Cecconi M et al (2017) Tissue Doppler assessment of diastolic function and relationship with mortality in critically ill septic patients: a systematic review and meta-analysis. Br J Anaesth 119:583–594
    • View reference on publisher's website
  65. Vieillard-Baron A, Slama M, Mayo P, Charron C, Amiel JB, Esterez C et al (2013) A pilot study on safety and clinical utility of a single-use 72-hour indwelling transesophageal echocardiography probe. Intensive Care Med 39:629–635
  66. Volpicelli G, Elbarbary M, Blaivas M, Lichtenstein DA, Mathis G, Kirkpatrick AW et al (2012) International evidence-based recommendations for point-of-care lung ultrasound. Intensive Care Med 38:577–591
  67. Mayo P, Volpicelli G, Lerolle N, Schreiber A, Doelken P, Vieillard-Baron A (2016) Ultrasonography evaluation during the weaning process: the heart, the diaphragm, the pleura and the lung. Intensive Care Med 42:1107–1117
  68. De Backer D, Creteur J, Preiser JC, Dubois MJ, Vincent JL (2002) Microvascular blood flow is altered in patients with sepsis. Am J Respir Crit Care Med 166:98–104
    • View reference on publisher's website
  69. den Uil CA, Lagrand WK, van der Martin E, Jewbali LS, Cheng JM, Spronk PE et al (2010) Impaired microcirculation predicts poor outcome of patients with acute myocardial infarction complicated by cardiogenic shock. Eur Heart J 31:3032–3039
    • View reference on publisher's website
  70. Edul VS, Enrico C, Laviolle B, Vazquez AR, Ince C, Dubin A (2012) Quantitative assessment of the microcirculation in healthy volunteers and in patients with septic shock. Crit Care Med 40:1443–1448
    • View reference on publisher's website
  71. De Backer D, Donadello K, Sakr Y, Ospina-Tascon GA, Salgado DR, Scolletta S et al (2013) Microcirculatory alterations in patients with severe sepsis: impact of time of assessment and relationship with outcome. Crit Care Med 41:791–799
    • View reference on publisher's website
  72. Sakr Y, Dubois MJ, De Backer D, Creteur J, Vincent JL (2004) Persistant microvasculatory alterations are associated with organ failure and death in patients with septic shock. Crit Care Med 32:1825–1831
    • View reference on publisher's website
  73. De Backer D, Donadello K, Taccone FS, Ospina-Tascon G, Salgado D, Vincent JL (2011) Microcirculatory alterations: potential mechanisms and implications for therapy. Ann Intensive Care 1:27
    • View reference on publisher's website
  74. Cohen ES, Law WR, Easington CR, Cruz KQ, Nardulli BA, Balk RA et al (2002) Adenosine deaminase inhibition attenuates microvascular dysfunction and improves survival in sepsis. Am J Respir Crit Care Med JID - 9421642 166:16–20
    • View reference on publisher's website
  75. Tachon G, Harrois A, Tanaka S, Kato H, Huet O, Pottecher J et al (2014) Microcirculatory alterations in traumatic hemorrhagic shock. Crit Care Med 42:1433–1441
    • View reference on publisher's website
  76. De Backer D, Hollenberg S, Boerma C, Goedhart P, Buchele G, Ospina-Tascon G et al (2007) How to evaluate the microcirculation: report of a round table conference. Crit Care 11:R101
    • View reference on publisher's website
  77. Ince C, Boerma EC, Cecconi M, De Backer D, Shapiro NI, Duranteau J et al (2018) Second consensus on the assessment of sublingual microcirculation in critically ill patients: results from a task force of the European Society of Intensive Care Medicine. Intensive Care Med 44:281–299
  78. Ospina-Tascon G, Neves AP, Occhipinti G, Donadello K, Buchele G, Simion D et al (2010) Effects of fluids on microvascular perfusion in patients with severe sepsis. Intensive Care Med 36:949–955
  79. Pottecher J, Deruddre S, Teboul JL, Georger J, Laplace C, Benhamou D et al (2010) Both passive leg raising and intravascular volume expansion improve sublingual microcirculatory perfusion in severe sepsis and septic shock patients. Intensive Care Med 36:1867–1874
  80. De Backer D, Creteur J, Dubois MJ, Sakr Y, Koch M, Verdant C et al (2006) The effects of dobutamine on microcirculatory alterations in patients with septic shock are independent of its systemic effects. Crit Care Med 34:403–408
    • View reference on publisher's website
  81. Rady MY, Nightingale P, Little RA, Edwards JD (1992) Shock index: a re-evaluation in acute circulatory failure. Resuscitation 23:227–234
    • View reference on publisher's website
  82. Andrews B, Muchemwa L, Kelly P, Lakhi S, Heimburger DC, Bernard GR (2014) Simplified severe sepsis protocol: a randomized controlled trial of modified early goal-directed therapy in Zambia. Crit Care Med 42:2315–2324
    • View reference on publisher's website
  83. Michard F, Boussat S, Chemla D, Anguel N, Mercat A, Lecarpentier Y et al (2000) Relation between respiratory changes in arterial pulse pressure and fluid responsiveness in septic patients with acute circulatory failure. Am J Respir Crit Care Med 162:134–138
    • View reference on publisher's website
  84. De Backer D, Heenen S, Piagnerelli M (2005) koch M, Vincent JL: pulse pressure variations to predict fluid responsiveness: influence of tidal volume. Intensive Care Med 31:517–523
  85. Myatra SN, Prabu NR, Divatia JV, Monnet X, Kulkarni AP, Teboul JL (2017) The changes in pulse pressure variation or stroke volume variation after a “tidal volume challenge” reliably predict fluid responsiveness during low tidal volume ventilation. Crit Care Med 45:415–421
    • View reference on publisher's website
  86. Chu H, Wang Y, Sun Y, Wang G (2016) Accuracy of pleth variability index to predict fluid responsiveness in mechanically ventilated patients: a systematic review and meta-analysis. J Clin Monit Comput 30:265–274
    • View reference on publisher's website
  87. Monnet X, Guerin L, Jozwiak M, Bataille A, Julien F, Richard C et al (2012) Pleth variability index is a weak predictor of fluid responsiveness in patients receiving norepinephrine. Br J Anaesth 110:207–213
    • View reference on publisher's website
  88. Mahjoub Y, Pila C, Friggeri A, Zogheib E, Lobjoie E, Tinturier F et al (2009) Assessing fluid responsiveness in critically ill patients: false-positive pulse pressure variation is detected by Doppler echocardiographic evaluation of the right ventricle. Crit Care Med 37:2570–2575
    • View reference on publisher's website
  89. Monnet X, Bataille A, Magalhaes E, Barrois J, Le Corre M, Gosset C et al (2012) End-tidal carbon dioxide is better than arterial pressure for predicting volume responsiveness by the passive leg raising test. Intensive Care Med 39:93–100

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