Clinical outcomes in patients undergoing elective coronary artery bypass graft surgery with and without utilization of pulmonary artery catheter-generated data.
OBJECTIVE
The purpose of this study was to determine the frequency of pulmonary artery catheter (PAC) quantitative data requirements for modifying patient management during and after elective coronary artery bypass graft (CABG) surgery.


METHODS
A prospective observational clinical trial.


METHODS
University tertiary referral center.


METHODS
Two hundred patients undergoing elective CABG surgery.


METHODS
Attending anesthesiologist and surgeon were blinded to PAC numeric values. These data could be revealed in the presence of at least 2 of the following criteria: (1) systolic blood pressure <90 mmHg, (2) central venous pressure >15 mmHg, (3) urine output <0.5 mL/kg/h, (4) pH <7.35/HCO(3) <18 mmol/L, (5) SaO(2) <95%/F(I)O(2) >80%, and (6) ST changes +/- 2 mm if the empiric treatment failed to restore normal hemodynamics within 10 minutes. All patients were classified into either blinded or unblinded PAC groups.


RESULTS
PAC data were unblinded in 46 (23%) patients. Preliminary diagnosis was confirmed in 28 (14%), and treatment was modified in 18 (9%) of these patients. Four (2%) patients were given additional fluid challenges, 10 (5%) patients received a combination of fluid challenges and inotropic support, 3 (1.5%) patients were started on vasoconstrictors, and 1 (0.5%) patient required insertion of an intra-aortic balloon pump. Patients in the unblinded PAC group had a higher prevalence of perioperative myocardial infarction, atrial fibrillation, and inotropic support; longer intubation times; and increased intensive care unit (ICU) and hospital lengths of stay.


CONCLUSIONS
This study confirmed the contention that insertion of a PAC can be safely delayed until the clinical need arises either in the operating room or in the ICU after elective CABG surgery.
Djaiani
George
G
Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada. george.djaiani@uhn.on.ca
Karski
Jacek
J
Yudin
Mark
M
Hynninen
Maria
M
Fedorko
Ludwik
L
Carroll
Jo
J
Poonawala
Humara
H
Cheng
Davy
D
D000328:Adult; D000368:Aged; D002315:Cardiopulmonary Bypass; D002407:Catheterization, Swan-Ganz; D002496:Central Venous Pressure; D001026:Coronary Artery Bypass; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D016277:Ventricular Function, Left