Summary
Recent and methodologically robust clinical trials have not shown any improvement of clinically relevant endpoints (i.e., mortality or hospital and intensive care unit length of stay) facilitated by using the pulmonary artery catheter (Swan-Ganz catheter). This holds true for a variety of intensive care settings with diverse underlying diseases. Most likely – as always after randomized- controlled clinical trials without a benefit in one group – insufficient power of the trials will be discussed among friends and foes of this symbol of intensive care medicine. Nevertheless, power is not an issue: a megatrial with thousands of patients may yield statistically significant differences between groups, but beyond the setting of a controlled trial these differences will most likely be negligible.
In selected patients with, e.g., pulmonary hypertension or congenital heart disease, the pulmonary artery catheter may be beneficial for diagnosis or treatment. However, users should always be aware of the many pitfalls and methodological constraints of this device when interpreting the measurements.
Despite the fascination for invasive hemodynamic assessment and the enthusiasm associated with the use of the Swan-Ganz catheter, intensivists need to accept that more than 40 years after the introduction of invasive hemodynamic measurements in the clinical setting there are still more questions than answers: in general, we lack valid devices, and protocols that provide proven benefits for monitoring and therapy of our patients. Thus, currently and in the foreseeable future we will mainly rely on arterial blood pressure and the cardiac index for our patient care.