The clinical assessment of cardiac performance and ventricular
preload is notoriously unreliable in critically ill patients.
Consequently, a number of technologies have been developed to provide
the clinician with indexes of cardiovascular function to assist in
therapeutic decision making. Foremost among these is the pulmonary
artery catheter (PAC). Indeed, the PAC has largely shaped the practice
of modern critical care. Yet, the information provided by the PAC is
largely misunderstood, and its efficacy is never proven. Recently,
continuous esophageal Doppler monitoring has emerged as an alternative
to pulmonary artery catheterization. This paper evaluates the clinical
utility of the PAC and esophageal Doppler monitoring in assessing the
hemodynamic status of ICU patients.