Cardiac output (CO) determination by pulmonary artery (PA) catheter has increasingly been criticised within the literature due to its invasive nature and poor correlation between the pressure measurements and intravascular volume status in mechanically ventilated patients. Consequently, alternative less invasive technologies to PA catheterisation are emerging within intensive care. One such novel technology are pulse contour CO (PCCO) systems. They establish comprehensive and continuous haemodynamic monitoring utilising a central venous catheter (CVC) and an arterial line. Furthermore, a key feature of this technology is its ability to produce intrathoracic volume measurements which may provide a better estimation of cardiac preload as well as indicate the presence and severity of pulmonary oedema. This article aims to discuss the theoretical basis and clinical application of PCCO systems, how PCCO systems differ from PA catheters and how the intrathoracic volume measurements are derived. Understanding these advanced concepts will ensure that clinicians are able to employ this innovative monitoring technology more effectively.