Wedge: Everyone elses favorite Swan number

The podcast delves into the complexities of using pulmonary artery catheters, specifically focusing on the wedge pressure measurement. It argues that the wedge, often misunderstood, shouldn't be the sole determinant in clinical decisions due to inter- and intra-patient variability in cardiac compliance. The discussion draws parallels between optimizing sarcomere length in skeletal muscle and cardiac function, emphasizing the importance of left ventricular end-diastolic volume as a preload determinant. The podcast also explores the limitations of relying solely on wedge pressure, influenced by factors like PEEP, and introduces the left ventricular end-diastolic volume index (LVEDVI) as an alternative, while cautioning against its uncritical application due to potential inaccuracies in tachycardic or hemodynamically unstable patients. Ultimately, the goal is to optimize preload to improve cardiac output and oxygen delivery, advocating for a holistic assessment beyond a single number.