THEO DÕI HUYẾT ĐỘNG LIÊN TỤC BỆNH NHÂN SỐC TIM BẰNG CATHETER SWAN – GANZ OXIMETRY

Abstract

Objective: To assess the clinical utility of continuous hemodynamic monitoring via Swan–Ganz pulmonary artery catheterization (PAC) in patients with cardiogenic shock and to identify procedural advantages and challenges encountered during its application in critical care settings. Methods: This prospective observational study included patients aged ≥18 years diagnosed with cardiogenic shock based on the IABP–SHOCK II (2012) criteria and who underwent invasive hemodynamic assessment using a Swan–Ganz catheter. Hemodynamic variables were continuously monitored and recorded at baseline (T0), 6 hours (T6h), 12 hours (T12h), and 24 hours (T24h) post-catheterization for trend analysis. Implementation feasibility was evaluated based on procedural time, success rate on first attempt, operator profile, and associated complications. Results: A total of 34 patients with cardiogenic shock secondary to acute myocardial infarction (AMI) who had undergone coronary revascularization via percutaneous coronary intervention (PCI) were enrolled. The mean age was 73.65 ± 15.5 years (range: 41–91), with male predominance (64.71%). The mean body mass index (BMI) was 23.9 ± 3.6 kg/m². Hypertension (64.7%) and type 2 diabetes mellitus (58.8%) were the most prevalent comorbidities. At baseline (T0), mean hemodynamic parameters across the cohort were as follows: Cardiac index (CI): 2.24 ± 0.7 L/min/m²; Cardiac power output (CPO): 0.79 ± 0.41 (W); Central venous pressure (CVP): 12.3 ± 5.69 mmHg; Pulmonary artery occlusion pressure (PAOP): 19.24 ± 6.5 mmHg; Pulmonary artery pulsatility index (PAPi): 1.83 ± 1.96; Mixed venous oxygen saturation (SvO₂): 62.15 ± 11.1%.  There were no statistically significant differences in initial CI, CPO, or CVP between survivors (n=25) and non-survivors (n=9). However, SvO₂ at T0 was notably higher in the survivor group (63.84 ± 8.87%) compared to non-survivors (57.44 ± 15.44%). During the first 24 hours of advanced hemodynamic support, both CI and CPO demonstrated an upward trajectory in survivors, indicating improved cardiac performance. Vasoactive-inotropic score (VIS) exhibited divergent trends between the two groups, survivors group: VIS decreased from 98.8 ± 107.9 (T0) to 81.5 ± 131.9 (T24) and non-survivors: VIS increased from 89.75 ± 24.65 (T0) to 92.5 ± 63.3 (T24).The in-hospital mortality rate was 26% (n=9). Conclusion: Early coronary revascularization combined with advanced hemodynamic resuscitation utilizing Swan–Ganz catheterization enables real-time, continuous assessment of preload, afterload, and cardiac performance. This facilitates individualized optimization of vasopressor and inotropic therapy, supporting adequate tissue perfusion while minimizing drug exposure. The integration of PAC-guided therapy may serve as a valuable strategy in improving hemodynamic stability and potentially reducing mortality in cardiogenic shock.