Potential impact of pulmonary artery catheter placement on short-term management decisions in the medical intensive care unit.
The purpose of this study was to examine the potential impact of pulmonary artery (PA) catheter placement on short-term management decisions in the medical intensive care unit (ICU). One hundred three patients were examined over an 18-month period. The predominant indications for PA-catheter placement included refractory congestive heart failure, airspace disease, uncertain cardiac filling pressures, or hypotension. In 58 (56%) of the 103 patients, management recommendations changed as a direct result of knowledge gained by PA catheter placement. These changes involved fluid therapy recommendations in 41 patients, vasopressor use in 17 patients, intravenous vasodilator use in 24 patients, and recommendations for the use of inotropic agents in 15 patients. Although 18 patients experienced early or late complications, major events were limited to a single pneumothorax requiring chest tube insertion and four episodes of bacteremia. No deaths were directly attributable to the catheter insertion. In critically ill patients in the medical intensive care unit, PA-catheter placement leads to changes in recommendations for management in a substantial portion of patients with little risk of life-threatening complications in those who receive such invasive monitoring.
Coles
N A
NA
Cardiac Unit, Massachusetts General Hospital, Boston 02114.
Hibberd
M
M
Russell
M
M
Love
T
T
Ory
D
D
Field
T S
TS
Dec
G W
GW
Eagle
K A
KA
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D016009:Chi-Square Distribution; D003325:Coronary Care Units / Q000706:statistics & numerical data; D003422:Critical Care / Q000706:statistics & numerical data; D016638:Critical Illness; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D011446:Prospective Studies; D011651:Pulmonary Artery