title: Assessment of the clinical effectiveness of pulmonary artery catheters in management of patients in intensive care (PAC-Man): a randomised controlled trial.
abstract: BACKGROUND
  Over the past 30 years the pulmonary artery catheter (PAC) has become a widely used haemodynamic monitoring device in the management of critically ill patients, though doubts exist about its safety. Our aim was, therefore, to ascertain whether hospital mortality is reduced in critically ill patients when they are managed with a PAC.
  
  
  METHODS
  We did a randomised controlled trial to which we enrolled 1041 patients from 65 UK intensive care units. We assigned individuals to management with (n=519) or without (n=522) a PAC. The timing of insertion and subsequent clinical management were at the discretion of the treating clinician. Intensive care units decided a priori to have the option of using an alternative cardiac output-monitoring device in control patients.
  
  
  RESULTS
  1014 patients were eligible for analysis. We noted no difference in hospital mortality between patients managed with or without a PAC (68% [346 of 506] vs 66% [333 of 507], p=0.39; adjusted hazard ratio 1.09, 95% CI 0.94-1.27). We noted complications associated with insertion of a PAC in 46 of 486 individuals in whom the device was placed, none of which was fatal.
  
  
  CONCLUSIONS
  Our findings indicate no clear evidence of benefit or harm by managing critically ill patients with a PAC. Efficacy studies are needed to ascertain whether management protocols involving PAC use can result in improved outcomes in specific groups if these devices are not to become a redundant technology.
authors.affiliation: Intensive Care National Audit and Research Centre, London, UK.
authors.forename: Sheila
authors.initials: S
authors.lastname: Harvey
authors.forename: David A
authors.initials: DA
authors.lastname: Harrison
authors.forename: Mervyn
authors.initials: M
authors.lastname: Singer
authors.forename: Joanne
authors.initials: J
authors.lastname: Ashcroft
authors.forename: Carys M
authors.initials: CM
authors.lastname: Jones
authors.forename: Diana
authors.initials: D
authors.lastname: Elbourne
authors.forename: William
authors.initials: W
authors.lastname: Brampton
authors.forename: Dewi
authors.initials: D
authors.lastname: Williams
authors.forename: Duncan
authors.initials: D
authors.lastname: Young
authors.forename: Kathryn
authors.initials: K
authors.lastname: Rowan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002407:Catheterization, Swan-Ganz / Q000009:adverse effects; D003422:Critical Care; D016638:Critical Illness; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D016896:Treatment Outcome