Resolved: A pulmonary artery catheter should be used in the management of the critically ill patient. Pro.
Selected studies showing both positive and negative outcomes with the use of pulmonary artery catheters (PACs) are reviewed. Indications for use of a PAC are controversial, although clearly the "red cap syndrome" is an indication for its insertion. There are sufficient data as well as personal experience to suggest that PACs do make a difference in the management of critically ill patients. Attention is focused on the level of physician expertise in interpreting data provided by PAC monitoring as the most critical limitation on the physician's ability to make appropriate clinical decisions. Studies are reviewed that addressed physician level of expertise related to PAC insertion, complications, data and waveform interpretation, and management. User knowledge clearly is suboptimal. Before attempting to draw conclusions from outcome studies, criteria for appropriate use need to be developed and clinician knowledge needs to be significantly improved.
Vender
J S
JS
Department of Anesthesiology, Northwestern University Medical School, Evanston, IL, USA.
D002302:Cardiac Output; D002405:Catheterization, Central Venous; D002407:Catheterization, Swan-Ganz / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D002983:Clinical Competence; D016638:Critical Illness; D003657:Decision Making; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D008991:Monitoring, Physiologic; D017063:Outcome Assessment, Health Care; D010100:Oxygen / Q000097:blood; D010347:Patient Care Planning; D015996:Survival Rate
D006454:Hemoglobins; D010100:Oxygen