Introduction: The routine application of transthoracal (TTE) and transesophageal echocardiography (TEE) extends diagnostic and consequently therapeutic opportunities of haemodynamic disorders. Pulmonary artery catheter (PAC) enables objective measurement and continuous monitoring of the selected parameters according to the type of the catheter. There is obvious contrib ution of TTE/TEE not only for the changes in therapy in 40% of patients without PAC but even in 40–50% of patients with already inserted PAC regardless to the main diagnosis. Methods: The authors attempted to define the haemodynamic diagnosis where PAC is indicated even after the repeated TTE/TEE investigation and where echocardiography alone is probably insufficient monitoring device. Haemodynamically unstable patients were enrolled to the study after the standard monitoring methods were exhausted. Patients were investigated by TTE and TEE was applied in case that TTE provided insufficient data. The number of investigations per one case was 2–10. PAC was indicated in case of persisting haemodynamic instability or signs of low cardiac output syndrome. The main haemodynamic diagnosis of the patients indicated to PAC insertion was recorded as well as mortality in the groups of PAC and of TTE/TEE and APACHE II on the day of the first echocardiographic investigation and on the day of PAC insertion. Results: 163 patients were included in the study and monitored initially by TTE. 33 of them (20.2%) were investigated by TEE. 134 were monitored only by echocardiography with mortality 33.6%, average APACHE II was 21.0 ± 12. 29 patients (17.8%) were consecutively indicated to PAC with higher overall mortality 48.3%, average APACHE II was insignificantly higher on insertion: 22.8 ± 8 (p > 0.05).The incidence of PAC among all admitted (ventilated) patients was 6.8%. PAC was inserted in 10 patients with significant left ventricular (LV) systolic dysfunction with EFLV<35% (34.5%) and in 14 patients with right ventricular (RV) dysfunction (48.3%). 2 patients were catheterized with arhythmias and LV diastolic dysfunction (6.9%). PAC was inserted in 3 patients who developed severe septic shock (10.3%). Conclusion: The rate of PAC insertion after repeated TTE/TEE investigation was approximately half of the average rate of the PAC insertion in an European I.C.U. APACHE II does not respond adequately to the significance of the haemodynamic deterioration when repeated echocardiographic investigation is not sufficient for the stabilizing of a patient. The study confirms the previous reports recommending PAC to be inserted only in haemodynamic instability of cardiac origin, the other causes could be probably safely managed with less invasive and cheaper echocardiographic monitoring. Severe left ventricular systolic dysfunction was not proved as the indication for PAC. The indication for PAC in right ventricular dysfunction slightly prevails in our patients. It is possibly caused by the worse assessment of pulmonary artery by Doppler measurement by TEE and especially by TTE in ventilated patients.

        Key words: echocardiography - pulmonary artery catheter - haemodynamics