How Is the Evaluation of Intravascular Volume and Fluid Responsiveness with the Swan-Ganz Catheter Used to Optimize Hemodynamics?

Abstract

  Swan-Ganz catheter has been effective in determining hemodynamics in critically ill patients. However, routine use has not been shown to provide benefits in morbidity and mortality, thus, an appropriate recommendation on clinical use of this catheter is required because of the potential complications. Pulmonary capillary wedge pressure (PCWP), which is an estimate of left ventricular end-diastolic pressure (LVEDP), has not been shown to predict fluid responsiveness in many goal-directed approaches, because the relationship between LVEDP and left ventricular end-diastolic volume (LVEDV) on the left ventricular compliance curve is nonlinear, and LVEDP has a smaller change under the optimum stroke volume. In contrast, LVEDP has a possibility of predicting fluid responsiveness in the condition where left ventricular compliance lowers, especially in severe aortic stenosis and hypertrophic cardiomyopathy. The Swan-Ganz catheter may be useful in the evaluation of left ventricular preload due to a greater change of LVEDP under this condition.