The use of the oesophageal Doppler monitor in the intensive care unit.

OBJECTIVE: To review the theory and clinical use of the oesophageal Doppler monitor (ODM) in the intensive care setting. DATA SOURCES: A literature search using the key-words in both Medline and Pubmed databases. Information concerning insertion techniques and various waveforms was also obtained from the manufacturers. SUMMARY OF REVIEW: Both clinical and non clinical means of assessing the cardiac output have inherent inaccuracies. Some methods (e.g. the pulmonary artery catheter) are associated with potentially life-threatening complications. The oesophageal Doppler monitor offers a less-invasive, real-time indicator of cardiac output. This review describes the theory of the ODM, the technique for its insertion, the waveforms seen in various pathological states and appraises the available literature on its use.
CONCLUSIONS: The ODM offers a minimally invasive means of continuous haemodynamic monitoring with an extremely low incidence of complications. It is easy to insert and has been validated against established methods of cardiac output monitoring. However, whilst it has been shown to be of particular benefit in guiding fluid management and peri-operative care, there is less evidence of its usefulness in guiding inotrope requirements. Additionally, any reduction in morbidity and resource consumption has not yet been reported to be associated with an improvement in ICU survival.