The esophageal Doppler as an alternative to the pulmonary artery catheter

Major surgery is associated with significant trauma and is a potential cause of multiple system organ failure and death. Measurement of cardiac output using a variety of techniques during the perioperative period has enabled us to optimize stroke volume and cardiac output proactively in an attempt to reduce postoperative complications. The pulmonary artery catheter has been widely used and is considered the gold standard for measuring cardiac output. However, recent reports of increase morbidity and mortality associated with pulmonary artery catheter use has prompted us to reevaluate its role in the perioperative environment. Technological advances have included the development of a number of new techniques for measuring cardiac output. Esophageal Doppler ultrasonography is a relatively noninvasive method for measuring stroke volume and cardiac output. It is user-friendly, and is the only noninvasive technology to date that has been used successfully to direct intraoperative fluid administration, resulting in improvement in outcome and significant reduction in hospital stay.