Clinical relevance of data from the pulmonary artery catheter.
The usefulness of parameters measured using the pulmonary artery catheter has been challenged because no benefit in patient outcome has been observed in clinical trials. However, technological advances have been made, including continuous measurement of cardiac output (CO), mixed venous saturation (SvO2), and right ventricle end-diastolic volume (CEDV) have been made. Pulmonary artery occlusion pressure (PAOP), CEDV and right atrial pressure (RAP) are not good predictors of fluid load responsiveness except when very low. Despite this methodological limitation, variation of these parameters during fluid loading remains a good indicator of fluid challenge tolerance. Accuracy of continuous thermodilution and SvO2 measurement has been demonstrated in vitro and at bedside. A decrease in SvO2 is a global index of an inadequate oxygen delivery (DO2)/oxygen requirement relationship. In this setting, a therapeutic decision to improve determinants of SvO2 should be considered with the help of all other PAC parameters. Technological improvement transforms PAC in a real time integrated physiological device and allows one to observe the impact of therapeutic intervention. What we need now is a clinical trial with a PAC-guided treatment algorithm taking into account the above integrated PAC parameters.
Robin
Emmanuel
E
Department of Anesthesiology and Critical Care, University Hospital, Lille, France. manurobin@free.fr
Costecalde
Marion
M
Lebuffe
Gilles
G
Vallet
Benoît
B
D001795:Blood Pressure Determination / Q000379:methods; D002302:Cardiac Output; D002407:Catheterization, Swan-Ganz / Q000295:instrumentation / Q000379:methods; D003422:Critical Care / Q000379:methods*; D006801:Humans; D008991:Monitoring, Physiologic / Q000379:methods*; D010100:Oxygen / Q000032:analysis; D011651:Pulmonary Artery / Q000378:metabolism; D011652:Pulmonary Circulation; D012680:Sensitivity and Specificity; D013318:Stroke Volume; D013815:Thermodilution / Q000379:methods
D010100:Oxygen