When I first became an ICU nurse, swans were wildly popular. Most ICU patients--regardless of their diagnosis--were swanned. Swans generate a flood of esoteric numbers, so they MUST be beneficial, right? ICU's had so many swans back then, they resembled aviaries!
The nurses spent a lot of time leveling, wedging and bolusing. And charting all those numbers. It was all paper charting back then--there was no such thing as downloading values from monitor to chart with a simple keystroke. We faithfully charted EDVI, SVI, SV, CO, CI, PAS, PAD, PAM, PAWP, PVR, SVR, SVRI, MAP, RAP and CVP into tiny cramped flowsheet boxes while call lights went off and patients called out for help. But, since this was IMPORTANT, we prioritized and charted on!
The result? Did the attending physician call at two in the morning to check on the pulmonary artery diastolic and add dobutamine? Did the cardiologist stop by, see the cardiac output and tweak the fluids? What was the impact of all this writing, flushing, leveling and wedging?
Not much.
I felt like someone who makes seven course dinner for guests who never show up. Why were we doing this? Is anybody there? Does anybody care?
Then studies started coming out demonstrating clearly that swans do not improve patient outcomes. In fact, with the combined risks of infection, overwedging, valvular damage, thrombus and pulmonary artery rupture, swans actually result in worse patient outcomes.
Younger physicians, current on the data, left the swans to fly in the wild (the cath lab and operating room). To evaluate sepsis and cardiogenic shock, they used less intrusive means.
When a swan is sighted now, it's almost always partnered with an old doctor too deaf to recognize the swan song.
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