Swan-Ganz Catheter and Lack of Evidence: Does it Reflect Clinical Practice?

The physician is faced with a septuagenarian patient with chronic heart failure (HF) of severe ischemic etiology. She progresses with a major hemorrhagic complication after attempted percutaneous revascularization. In spite of volume compensation, she shows signs of respiratory infection, and, notwithstanding adequate antibiotic therapy, she continues to deteriorate clinically with signs of hypoperfusion, albeit with borderline blood pressure levels.

Would indication of invasive hemodynamic monitoring be scientifically associated with reduced clinical outcomes in this case? Acute clinical syndromes imply a greater degree of difficulty for conducting clinical trials, and some approaches applied in practice have not yet been tested in the ideal Cartesian model. The case described above seems to be a good justification for this discussion.

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