Let us use the pulmonary artery catheter correctly and only when we need it.
OBJECTIVE
To clarify the issues related to the use of the pulmonary artery catheter within a rational clinical perspective.


RESULTS
Barriers include a) increased patient risk of pulmonary artery catheter placement; b) ability to measure similar variables via central venous catheterization, echocardiography, or other less invasive techniques; c) increased cost; d) inaccurate measurements; e) incorrect interpretation and application of pulmonary artery catheter-derived variables; and f) lack of proven benefit of pulmonary artery catheter use in the overall management of patients.


CONCLUSIONS
a) The risks are mainly due to insertion of a central catheter, not a pulmonary artery catheter; b) continuous monitoring of left ventricular filling pressures, pulmonary vascular pressures, and mixed venous oxygen saturation is a unique feature; c) additional costs are minimal relative to the cost of intensive care; d) measurement errors require ongoing programmatic educational efforts; e) pulmonary artery catheter-derived data need to be used within the context of a defined treatment protocol; and f) no monitoring device, no matter how simple or sophisticated, will improve patient-centered outcomes unless coupled with a treatment that, itself, improves outcome.


CONCLUSIONS
A treatment protocol for the use of pulmonary artery catheter-derived variables is proposed that could serve as a basis for a prospective clinical trial.
Pinsky
Michael R
MR
Department of Critical Care Medicine, Bioengineering and Anesthesiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Vincent
Jean-Louis
JL
D001291:Attitude of Health Personnel; D002407:Catheterization, Swan-Ganz / Q000009:adverse effects* / Q000379:methods; D003422:Critical Care; D006801:Humans; D018570:Risk Assessment