I'm in a cardiovascular surgical ICU, so every post-op heart comes back with a Swan. We have rather a love/hate relationship with them; they're great for accurate hemodynamics, but as long as the Swan stays in, the patient has to stay in bed, which makes us look bad on early mobility goal measures. Hence, we're seeing a few of our docs and midlevels start pushing for Vigileo FloTrac on patients whom they want mobilized but still want hemodynamic monitoring. Therein lies the rub.
My issue with FloTrac, and by extension most of the minimally invasive devices (whether they run off a radial A-line or a bioimpedance method) has to do with the accuracy of the system under one of the reps' biggest selling points - namely that such systems claim to provide hemodynamic profiling that doesn't require the patient to be vented and bedbound. For an intubated, vented, bedbound patient on a pile of drips (i.e. your average MICU player), Swan and FloTrac are probably going to come up with pretty similar numbers, and FloTrac might well be the better choice. However, once your patent is extubated and starting to get mobile, the FloTrac becomes less and less reliable, to the point where it eventually starts giving you voodoo numbers. If you have a patient who still needs hemodynamic profiling at that point (worried about low CO/CI r/t hx systolic failure or hx cardiogenic shock, need to titrate inotropes, whatever), the machine starts turning from a friend into a frenemy. FloTrac's accuracy also suffers if your patient is arrhythmic for whatever reason (A-fib, higher order AV blocks, other sinus and supraventricular arrhythmias, etc). As a result, I've seen nurses, midlevels and physicians all trying to manage patients - and erring badly - as a result of inaccurate FloTrac data.
In a case of serendipity, I had an extensive discussion with our local Edwards Lifesciences rep yesterday about just this issue. According to her, there's a next generation system coming out Real Soon Now that aims to address all those issues and more. Personally, I won't be holding my breath.