Invasive hemodynamic monitoring in the United Kingdom. Enough or too little?
In response to a questionnaire regarding use of invasive hemodynamic monitoring techniques in the United Kingdom, 211 replies were received from 276 hospitals (76.4 percent). Over one fifth of Intensive Care or combined Intensive/Coronary Care Units did not use pulmonary artery catheters (PAC); of those that did, two thirds used no more than two/month, and only two units used more than ten/month. Nearly a quarter did not possess a cardiac output computer. Only 18 complications occurring in the preceding year were reported, which suggests underrecognition. Clinical indications and lack of expertise were the main reasons proferred for limited use; however, cost (which was generally underestimated) and clinical value also were mentioned. The majority of CCUs did not use PACs, and only 10 percent used more than two/month. Only 10 percent of hospitals have used them perioperatively and most cardiothoracic units used no more than two PACs/month. In view of the large difference in numbers used between the United Kingdom and the United States, a large-scale study is warranted to determine the actual value of PACs in reducing mortality and morbidity.
Singer
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Department of Medicine, St. George's Hospital Medical School, London, England.
Bennett
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D002406:Catheterization, Peripheral / Q000706:statistics & numerical data; D003325:Coronary Care Units; D003365:Costs and Cost Analysis; D006439:Hemodynamics; D006801:Humans; D007362:Intensive Care Units; D008991:Monitoring, Physiologic / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D006113:United Kingdom