I used to like placing pulmonary artery catheters in ICU. I considered it to be the ultimate ICU medicine. I am still good at it; I just don’t do it very often. Last time I placed a PA catheter it caused some”distress” among ICU nurses since nobody knew how to calibrate the box. We ended up calling help from OR. Less and less residents/ fellows are being trained in this procedure. I have to admit PA catheter placement in medical ICU becoming an obsolete procedure. So, what is the next big thing?
Although, I do not have any formal training in reading ECHOs, I found myself looking at every single one done on my patients. I often watch ECHO “live” as it’s being done at the bedside. There is enough information you can derive from ECHO to help with the management. The questions like “what is the volume status?” or “what’s the cardiac function?” could be answered immediately at the bedside without subjecting the patient to the risks of the invasive procedure. Of course, ECHO lacks some of the benefits of the PA catheter like continuous monitoring capacity or wedge pressure etc. Still, my vote is – Echocardiography is the way to go.