Routine pulmonary artery catheterization does not reduce morbidity and mortality of elective vascular surgery: results of a prospective, randomized trial.
OBJECTIVE
The authors determined whether the preoperative placement of a pulmonary artery catheter (PAC) with optimization of hemodynamics results in outcome improvement after elective vascular surgery.


BACKGROUND
The PAC commonly is used not only in patients who are critically ill, but also perioperatively in major elective surgery. Few prospective studies exist documenting its usefulness.


METHODS
One hundred four consecutive patients were randomized to have a PAC placed the morning of operation (group I) or to have a PAC placed only if clinically indicated (group II). Group I patients were resuscitated to preestablished endpoints before surgery and kept at these points both intraoperatively and postoperatively. Group II patients received standard care.


RESULTS
There was one death in each group. An intraoperative or postoperative complication developed in 13 patients in group I versus 7 patients in group II (p = not significant). Group I patients received more fluid than did group II patients (5137 +/- 315 mL vs. 3789 +/- 306 mL; p < 0.003). There was no significant difference in either overall or surgical intensive care unit length of stay. Only one patient in group II required a postoperative PAC.


CONCLUSIONS
Routine PAC use in elective vascular surgery increases the volume of fluid given to patients without demonstrable improvement in morbidity or mortality.
Bender
J S
JS
Department of Surgery, Johns Hopkins Bayview Medical Center and The Johns Hopkins University School of Medicine, Baltimore, Maryland 21224, USA.
Smith-Meek
M A
MA
Jones
C E
CE
D000368:Aged; D002406:Catheterization, Peripheral; D002408:Catheters, Indwelling; D016009:Chi-Square Distribution; D000077324:Crystalloid Solutions; D004526:Efficiency; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D007552:Isotonic Solutions; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010952:Plasma Substitutes / Q000008:administration & dosage; D011182:Postoperative Care; D011300:Preoperative Care; D011446:Prospective Studies; D011651:Pulmonary Artery; D015532:Rehydration Solutions / Q000008:administration & dosage; D015996:Survival Rate; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects* / Q000401:mortality
D000077324:Crystalloid Solutions; D007552:Isotonic Solutions; D010952:Plasma Substitutes; D015532:Rehydration Solutions