Hemodynamic monitoring is evolving. The traditional method of monitoring hemodynamics over the past 30 years-the Swan-Ganz or pulmonary artery catheter (PAC)-has been under criticism for failing to show improved patient outcomes. While this criticism has certainly not eliminated PAC use, it has decreased use of this traditional form of hemodynamic monitoring.

While the PAC may be controversial, the measurement of hemodynamics is not at all controversial. Clinicians continue to desire hemodynamic information about their patients and have used the current debate to push for improved technology to obtain this information. Experts in the field have been working to adapt the current technology and searching for better technologies to measure hemodynamic parameters.

In this issue of The Journal of Cardiovascular Nursing (15:2), we not only focus on providing information that will assist the clinician to optimally use current technology but also glimpse into the future of hemodynamic monitoring. Some technologies, such as esophageal Doppler and exhaled CO₂ monitoring, are very close to clinical application. Undoubtedly, in the near future noninvasive technologies will be so commonplace that hemodynamic monitoring will be performed almost everywhere, including home health. I sometimes joke that when the noninvasive technologies are available and the cost is low enough, we will see them sold in discount stores like Wal-Mart.

In a more practical manner, this issue attempts to improve the care provided with the current technology in three ways. First, it addresses areas where clinicians have been shown to need improvement in knowledge, such as indications for hemodynamic monitoring and hemodynamic waveform analysis. In addition, it presents expanded uses of hemodynamic monitoring (eg, in the mechanical ventilator weaning population). Second, it describes specialized catheters that have limited clinical use (eg, SvO₂, continuous cardiac output, and right ventricular ejection fraction catheters). These discussions focus on how new technologies can be optimally employed to improve patient outcomes. Third, it describes the use of an emerging, complementary technology (ie, capnography) to illustrate how this underutilized technology can provide valuable hemodynamic information. Capnography appears poised to take a prominent role in critical care in the very near future.

The bottom line for any hemodynamic monitoring technology is its use by clinicians. Technologies are only as effective as the clinicians who employ them. There is no technology that can have an impact without a skilled clinician using it. Moreover, hemodynamic measurement is not helpful if the measurements are inaccurate. This issue specifically addresses the importance of accuracy in hemodynamic measurement.

We hope these articles help achieve the goal of developing skilled, knowledgeable clinicians. If we can facilitate this goal in any way, then this issue of JCN will be an important contribution to cardiac care.

-Tom Ahrens, DNS, RN, CCRN, CS

Guest Editor