Pulmonary artery catheter

Device	Degree of invasiveness	Advantages	Disadvantages
PAC	Invasive	- Continuous CO measurement (gold standard) - Ability to measure multiple haemodynamic variables - Right ventricular pressures - Distinguish between left and right heart pathologies	- Invasiveness - Complications associated with catheter insertion
PiCCO	Minimally invasive	- Continuous CO measurement - Ability to measure multiple static and haemodynamic variables	- Arterial waveform artefact may significantly affect data accuracy - Inaccurate with severe AR, arrhythmias or IABP - Requires transpulmonary thermodilution calibration (repeated) - Requires central arterial and venous access - Inability to measure PAP
LiDCO	Minimally invasive	- Continuous CO measurement - Useful in intraoperative goal-directed therapy	- Arterial waveform artefact may significantly affect data accuracy - Inaccurate with severe AR, arrhythmias or IABP - Requires transpulmonary lithium dilution calibration (repeated) - Contraindicated in patients taking lithium - Calibration affected by use of neuromuscular blocking drugs - Inability to measure PAP and EVLW
FloTrac	Minimally invasive	- Continuous CO measurement - Useful in intraoperative goal-directed therapy	- Arterial waveform artefact may significantly affect data accuracy - Inaccurate with severe AR, arrhythmias or IABP - Inaccurate in patients with decreased vascular tone (e.g. septic shock, liver disease)
Oesophageal Doppler	Minimally invasive	- Useful in goal-directed therapy	- Makes assumptions regarding aortic size and proportional blood flow - Operator dependent - Poorly tolerated unless patient's trachea is intubated
Echocardiography	TOE: invasive, TTE: non-invasive	- Useful in evaluation of cardiac function, anatomy and pre-load - Real-time imaging	- Requires significant training and expertise - Operator dependent - Continuous monitoring not available - Oesophageal injury

References

The Contemporary Pulmonary Artery Catheter. Part 1 Placement and Waveform Analysis