Which general intensive care unit patients can benefit from placement of the pulmonary artery catheter?
From the report by Connors and coworkers in 1996 until now, much effort has been directed at demonstrating the safety and/or effectiveness of strategies based on pulmonary artery catheter (PAC) data. Although studies have failed to demonstrate a clear benefit of PAC use, neither have any corroborated the initial report of PAC-induced mortality. With this in mind, it is important to clarify the indications for PAC, taking into account the development of new technologies to measure cardiac output and stroke volume. The present review focuses on safety and effectiveness data, with a special focus on reasonable indications for PAC use in the intensive care unit. The PAC has evolved since its initial presentation, and it now offers numerous parameters in addition to cardiac output and pressure measurement, such as mixed oxygen saturation and right ventricular ejection fraction. Because many techniques may be used to measure cardiac output, the indications for PAC use have become founded on other parameters that are useful in more specific situations, essentially involving the right circulation.
Payen
Didier
D
Department of Anesthesiology & Critical Care Medicine, Lariboisière University Hospital, Paris, France. dpayen1234@aol.com
Gayat
Etienne
E
D002407:Catheterization, Swan-Ganz; D003422:Critical Care / Q000379:methods* / Q000592:standards; D006333:Heart Failure / Q000175:diagnosis / Q000628:therapy; D006801:Humans; D008991:Monitoring, Physiologic / Q000379:methods; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D012128:Respiratory Distress Syndrome / Q000175:diagnosis / Q000628:therapy; D018570:Risk Assessment / Q000379:methods; D018805:Sepsis / Q000175:diagnosis / Q000628:therapy; D016896:Treatment Outcome