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Objective: It has been recently shown that there is a match between dicrotic notch and mean pulmonary artery (PA) pressures in spontaneously breathing patients studied by means of high-fidelity pressure catheters. The aim of the study was to analyze the relation between mean PA pressure and PA pressure at the incisura by using a Swan-Ganz catheter in critically ill, mechanically ventilated patients. Measurements and results: Fluid-filled PA pressures were obtained over four ventilatory cycles in 32 consecutive, mechanically ventilated patients in the intensive care unit. We measured mean PA pressure and dicrotic notch pressure. We also calculated the widely used approximation of mean PA pressure (mean PAPapprox = diastolic + 1/3 pulse pressure). Cardiac output was measured in triplicate by using the thermodilution technique. Dicrotic notch was clearly identified in 30 of 32 patients. Mean PA pressure (32.1 ± 10.2 mm Hg) and PA dicrotic notch pressure (31.8 ± 10.4 mm Hg) were linearly related (r = 0.989, p < 0.001). Agreement between dicrotic notch and mean PA pressures was suggested (mean difference ± SD = − 0.3 ± 1.5 mm Hg). Similar agreement was found between mean PAPapprox and mean PA pressure (mean difference ± SD = − 0.7 ± 0.8 mm Hg; p = 0.20). Conclusion: By using a Swan-Ganz catheter we found that dicrotic notch pressure equalled mean PA pressure in the critically ill, mechanically ventilated patients studied. This indicated that right-sided ejection was completed at a PA pressure equal to mean PA pressure in these patients.

A 75-year-old woman suffered severe haemoptysis after insertion of a Swan-Ganz catheter in an intensive care unit. Control of the pulmonary artery haemorrhage was quickly and successfully achieved with stainless steel coils as the embolic material.

A case of pulmonary artery rupture induced by balloon occlusion pulmonary angiography (BOPA) is reported. A flow-directed pulmonary artery catheter had been inserted for hemodynamic monitoring in a septic shock patient complicated by acute respiratory distress syndrome. To check for pulmonary damage, BOPA was performed immediately after hemodynamic measurement. Just as the hand injection of contrast medium was ending, the patient began to cough and a small amount of hemoptysis was observed. The angiogram showed the extravasation of contrast medium from the distal pulmonary artery to the situation of catheter tip. Pulmonary hemorrhage was controlled with mechanical ventilatory support with 10 cmH2O positive end-expiratory pressure and no specific therapy was required. This complication should be kept in mind and using a power injector to avoid injurious transient high pressure pulse is recommended.

We report the case of a 29-year-old man with decompensated alcoholic cardiomyopathy who developed a Staphylococcal pulmonic valve infective endocarditis during hemodynamic monitoring, as a consequence of catheter-related bacteremia. As experimentally demonstrated, the damaging role of the pulmonary artery catheter on the endocardial surface plays a major role in the pathogenesis of related right-sided infective endocarditis. Occurrence of bacteremia in a catheterized patient should be considered as a high risk situation, and righ-heart infective endocarditis must be suspected whenever patient presents fever or bacteremia without obvious site of infection. Doppler echocardiography is the reference diagnosis procedure.

With its potential to initiate more serious pulmonary complications, atelectasis requires prompt, effective therapy. We present three cases of patients who, when conventional measures failed, were treated with a technique we devised using a flexible fiberoptic bronchoscope and Swan-Ganz catheter to selectively insufflate the collapsed area. The technique effectively re-expanded the patients' lung.

Measurements of stroke volume (SV) by echo-Doppler techniques (2D-echocardiography, continuous and pulsed Doppler) were compared to those obtained by thermodilution in 116 critically ill patients. The best correlation was obtained with pulsed Doppler positioned in the left ventricular (LV) outflow (r = 0.78, p less than 0.001). In a subgroup of 12 patients who had LV ejection fraction less than 60% and LV end-diastolic pressure greater than 15 mmHg, we also measured the peak aortic blood velocity (PABV) and acceleration (PABA) by continuous and pulsed Doppler as indexes of myocardial contractility before coronary artery bypass graft. When compared to healthy volunteers, these patients had decreased PABV and PABA, measured by continuous Doppler (91 +/- 16 vs 79 +/- 9 cm/s, p less than 0.05 and 913 +/- 202 vs 660 +/- 149 cm/s/s, p less than 0.05, respectively). These data therefore indicate that in critically ill patients pulsed Doppler placed in the LV outflow is an adequate echo-Doppler technique to measure SV, while continuous Doppler placed in the suprasternal notch can be used to assess LV performance.

The use of flow directed Swan Ganz catheters has provided an additional dimension in improving patient care in the intensive care units. We undertook repeated Swan Ganz catheterization in 26 patients with congestive cardiac failure on 65 occasions to evaluate the effect of vasodilator drugs. The same internal jugular vein was used. No significant complications were noted.

Placement of a Swan-Ganz catheter can cause many complications. This case report presents a new complication of Swan-Ganz catheter insertion--placement of the Swan-Ganz catheter tip in the coronary sinus.

A case is described in which voluntary ingestion of 72 g meprobamate (mpb) was complicated by shock ascribed to cardiac failure and vasodilation, documented by hemodynamic monitoring. Forced diuresis and cardiac inotropic support were added to the therapy. We recommend Swan-Ganz monitoring in any case of mpb overdosage associated with hypotension and suggest that forced diuresis is not contraindicated if appropriate assessment of the patient's hemodynamic condition is performed.

A case of collapse of the right middle and lower lobes associated with pulmonary artery catheterisation is described. Possible mechanisms are discussed.