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 h emodynamic indices; however, it has recently been criticized. This study wa s undertaken to evaluate an esophageal Doppler monitor (EDM) as a possible replacement for PA catheter in critically ill, mechanically ventilated pati ents, Methods: EDM and PA catheters were placed in patients in the surgical inten sive care units (n = 14, 118 matched sets of data). PA catheter and EDM mea surements, including corrected flow time (FTc,) a measure of preload, were obtained. Pearson correlation (r) was analyzed to compare PA catheter and E DM measurements, and a nonlinear regression model was used to describe Star ling Relationships. Results: Cardiac output correlated between EDM and PA c atheter (r = 0.6; p < 0.001), FTc correlated more strongly with cardiac out put than did pulmonary capillary wedge pressure. (FTc: r(2) = 0.27; p < 0.0 01; cardiac output: r(2) = 0.04; p = 0.06). Conclusion: Corrected flow time is a better indicator of preload than pulmo nary capillary wedge pressures. EDM seems to be at least as useful as PA ca theter in managing the hemodynamic status of critically ill surgical patien ts.