Esophageal Doppler Monitoring for Hemodynamic Assessment

The use of continuous electrocardiography, pulse oximetry, blood pressure monitoring, and capnography are the standard of care in ICUs throughout the world. The information gained from these technologies in combination with physical assessment is invaluable to clinicians but does not provide hemodynamic or, most important, blood flow information. The limitation of physical assessment when making hemodynamic decisions has been previously described [1,2]. Clinicians need additional information to assist in making critical decisions and often use hemodynamic monitoring, which includes cardiac output/index, stroke volume/index, and assessments of preload and afterload. The pulmonary artery catheter (PAC) was developed to aid with that assessment and has been considered the clinical standard. The complexity of the PAC requires clinicians to be familiar with the operations of transducers, thermodilution cardiac output monitoring, and waveform analysis. Clinicians’ knowledge of the PAC is often substandard, and it can be difficult to become and remain clinically competent [3–5]. The lack of improved outcomes associated with the PAC and overcoming the technical difficulties has resulted in some clinicians abandoning the use of the PAC [6]. Complications associated with the use of the PAC such as venous thrombosis, arrhythmias, pneumothorax, and cathe-