Is there a role for continuous esophageal Doppler in critically ill patients?

Introduction

Esophageal Doppler is a noninvasive method used to guide fluid loading, resulting in clinical outcome benefits, especially during anesthesia. Its role in critically ill patients is still controversial.

Objective

To compare cardiac output (CO) obtained from esophageal Doppler with thermodilution, using a Swan–Ganz catheter.

Methods

Data was obtained from two medical intensive care units between February and March 2003. An esophageal probe for cardiac output monitoring was introduced in severe sepsis and septic shock patients when a pulmonary artery catheter was indicated by the attendant physician; four CO measurements were done for each patient with 6-hour intervals. CO determination by esophageal Doppler was performed simultaneously with thermodilution.

Results

Eight consecutive patients with a mean age of 61.1 years were included (five females and three males). Twenty-five measurements were done; as shown in Figure 1 there was no correlation (R² = 0.02) between thermodilution and esophageal Doppler CO measurements. Figure 2 shows that no correlation was seen when we analysed only the variations of CO measurements (R² = 0.4; P = 0.11).

Figure 1

Figure 2

Conclusion

In this study, in concordance with published data, there is no evidence to support esophageal Doppler as a technique for CO continuous monitoring in the intensive care unit.