Resolved: A pulmonary artery catheter should be used in the management of the critically ill patient. Con.
Complications associated with pulmonary artery catheters (PACs) include interpretation errors, insertion problems, sepsis, thrombosis, and dysrhythmias. Alternatives to the use of PACs include the central venous pressure catheter, measurement of cardiac output by thoracic electrical bioimpedance, gastric tonometry and the measurement of serum lactate level, and the still to be released fiberoptic PCO2 sensor developed to provide a continuous measure of intramucosal PCO2. Outcome studies show conflicting results. Selected outcome studies conducted since 1987 are briefly reviewed, including studies of the use of PACs to achieve supranormal therapy. There are insufficient data from prospective, randomized, and adequately controlled studies to determine whether PAC use reduces mortality and morbidity rates. Until such evidence becomes available, a PAC should not be used routinely in critically ill patients, and its use should not be considered the only standard of care.
Becker
K
K
Department of Anesthesiology, University of Kansas School of Medicine, Wichita 67214, USA.
D001145:Arrhythmias, Cardiac / Q000209:etiology; D002245:Carbon Dioxide / Q000032:analysis; D002302:Cardiac Output; D002405:Catheterization, Central Venous; D002407:Catheterization, Swan-Ganz / Q000009:adverse effects / Q000295:instrumentation; D016638:Critical Illness; D017097:Electric Impedance; D005336:Fiber Optic Technology / Q000295:instrumentation; D006801:Humans; D007773:Lactates / Q000097:blood; D017063:Outcome Assessment, Health Care; D011312:Pressure; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D018805:Sepsis / Q000209:etiology; D013270:Stomach / Q000502:physiology; D015996:Survival Rate; D013927:Thrombosis / Q000209:etiology; D014018:Tissue Distribution
D007773:Lactates; D002245:Carbon Dioxide