Assessment of the clinical effectiveness of pulmonary artery catheters in management of patients in intensive care (PAC-Man): a randomised controlled trial

  title={Assessment of the clinical effectiveness of pulmonary artery catheters in management of patients in intensive care (PAC-Man): a randomised controlled trial},
  author={Sheila Harvey and David A. Harrison and Mervyn Singer and Joanne Ashcroft and Carys Jones and Diana Elbourne and William Brampton and Dewi Williams and Duncan Young and Kathryn M. Rowan},
  journal={The Lancet},

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Impact of pulmonary artery catheter in critically ill patients

It was found that use of the PAC neither increased mortality nor conferred any real benefit, so PAC use should not be routine in critically ill patients but should serve a specific purpose consistent with clinical decision making.

Pulmonary Artery Catheters for Adult Patients in Intensive Care.

There have been two multi-centre trials of the effectiveness of PACs for managing critically ill patients admitted to intensive care, although only one was adequately powered.

Does the Pulmonary Artery Catheter Still Have a Role in the Perioperative Period?

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The pulmonary artery catheter is a monitoring device and information alone is unlikely to influence outcome unless it is linked to a proven therapy, but its routine use is difficult to justify and increasingly, most of the haemodynamic data available from the PAC can be obtained less invasively with echocardiography.

The Pulmonary Artery Catheter in the Perioperative Setting: Should It Still Be Used?

The pulmonary artery catheter was introduced into clinical practice in the 1970s and was initially used to monitor patients with acute myocardial infarctions, but it still remains a valuable tool in a wide variety of clinical settings.

Impact of the pulmonary artery catheter in critically ill patients: meta-analysis of randomized clinical trials.

In critically ill patients, use of the pulmonary artery catheter neither increased overall mortality or days in hospital nor conferred benefit, and the neutrality of the PAC for clinical outcomes may result from the absence of effective evidence-based treatments to use in combination with PAC information.

Pulmonary artery catheters for adult patients in intensive care.

It is concluded that use of a PAC did not alter the mortality, length of stay (LOS) in intensive care unit (ICU) and hospital and cost of care in adult intensive care patients, and the clinical, methodological and statistical heterogeneity was high.

The pulmonary artery catheter: is it still alive?

The PAC still has an important role in the cardiopulmonary monitoring of critically ill patients and the decrease in use may unfortunately limit exposure of junior doctors and nurses to this device, so that they become less familiar with using the PAC, making it more complicated and less optimal.

The Current Role of the Pulmonary Artery Catheter in Critical Care: A Case Report and Review of the Literature

It is suggested that PAC insertion may be of little benefit unless linked to specific therapies which may alter outcome and it is essential to understand the capabilities and limitations of the PAC in order to minimise potential complications and maximise benefits.

The Pulmonary Artery Catheter in the Management of the High-Risk Surgical Patient

The PAC became a standard tool for hemodynamic monitoring in patients during critical illness conditions and the tool of choice for managing perioperative hemodynamic optimization in high-risk patients.



A randomised, controlled trial of the pulmonary artery catheter in critically ill patients

The results suggest that the PAC is not associated with an increased mortality and should be considered as a viable treatment option for critically ill patients.

Use of pulmonary artery catheters in patients with acute myocardial infarction. Analysis of experience in 5,841 patients in the SPRINT Registry. SPRINT Study Group.

While a higher in-hospital mortality is found in patients receiving PAC, this excess is likely related to difference in severity of CHF, which had not been assessed in every individual.

The effectiveness of right heart catheterization in the initial care of critically ill patients. SUPPORT Investigators.

RHC was associated with increased mortality and increased utilization of resources, and these findings justify reconsideration of a randomized controlled trial of RHC and may guide patient selection for such a study.

The incremental cost effectiveness of withdrawing pulmonary artery catheters from routine use in critical care

The results of this study indicate that withdrawal of PACs from routine clinical use in ICUs within the NHS would be considered cost effective in the current decision-making climate.

Is it time to pull the pulmonary artery catheter?

Despite the widespread use of this procedure and its attendant costs, there is no evidence that it benefits patients, and its use has not been shown to decrease patient morbidity or mortality.

Is the pulmonary artery catheter misused? A European view.

A moratorium on pulmonary artery catheter use is not necessary and clinical trials in heterogeneous ICU populations are not warranted, and improved training in the insertion, interpretation, and implementation of the pulmonary arteries catheter and the data it generates is required.

A community-wide assessment of the use of pulmonary artery catheters in patients with acute myocardial infarction.

In conclusion, it could not demonstrate a beneficial effect associated with the use of the PA catheter on selected patient outcomes, including in-hospital and long-term prognosis and average hospital stay, in this community-wide study of patients hospitalized with acute MI.

Complications of hemodynamic monitoring.

A multicenter study of physicians' knowledge of the pulmonary artery catheter. Pulmonary Artery Catheter Study Group.

Given the variability in physician understanding of the pulmonary artery catheter, credentialing policies should be reevaluated and consideration should be given to restricting its use to individuals with documented competency.

Intensive care physicians' insufficient knowledge of right-heart catheterization at the bedside: time to act?

Korean intensive care physicians' knowledge of right-heart pulmonary artery catheterization is not uniformly good among ICU physicians, andAccreditation policies and teaching practices concerning this technique need urgent revision.