Current use of the pulmonary artery catheter

@article{Greenberg2009CurrentUO,
  title={Current use of the pulmonary artery catheter},
  author={Steven B. Greenberg and Glenn S. Murphy and Jeffery Vender},
  journal={Current Opinion in Critical Care},
  year={2009},
  volume={15},
  pages={249–253}
}
Purpose of reviewThe pulmonary artery catheter is one of the most scrutinized monitors used in intensive care today. Pulmonary artery catheter use is declining due to limited demonstrated beneficial outcomes and the advancement of less invasive monitoring. This study discusses the current use of the pulmonary artery catheter and problems associated with its use including inaccuracy of measurements and data interpretation, inappropriately applied therapeutic interventions, inappropriate delays… 
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28 Citations
Highly Influential Citations
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Background Citations
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Methods Citations
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28 Citations

Citation Type

Citation Type

Pulmonary Artery Catheters for Adult Patients in Intensive Care.
TLDR
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.
Pulmonary artery catheters for adult patients in intensive care.
TLDR
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 Current Role of the Pulmonary Artery Catheter in Critical Care: A Case Report and Review of the Literature
TLDR
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.
History of Right Heart Catheterization: 100 Years of Experimentation and Methodology Development
TLDR
The purpose of this manuscript is to review the development of right heart catheterization that led to the ability to conduct physiologic studies in cardiovascular dynamics in normal individuals and in patients with cardiovascular diseases, and to review current controversies of the extension of the right heartCatheter, the pulmonary artery catheter.
Increasing Use of Less-Invasive Hemodynamic Monitoring in 3 Specialty Surgical Intensive Care Units
TLDR
In a 5-year period, the decreased insertions of PACs were replaced by increased utilization of less-invasive hemodynamic monitoring devices, and this change in practice did not adversely impact mortality.
Short and Mid-Term Economic Impact of Pulmonary Artery Catheter Use in Adult Cardiac Surgery: A Hospital and Integrated Health System Perspective
TLDR
PAC utilization in adult cardiac surgery patients results in reduced costs for both acute care hospitals and payer-provider integrated health systems.
Use of echocardiography and modalities of patient monitoring of trauma patients
TLDR
Echocardiography plays an important role in the trauma bay for diagnosis of thoracic injury and at the bedside in the ICU for evaluation of the hemodynamic profile and can be performed through either the transesophageal or transthoracic route.
Right Cardiac Catheterization Before the Advent of Cardiopulmonary Bypass
TLDR
After more than 50 years from its inception, right heart catheterization continues to be the gold standard in diagnosing patients with elevated right heart pressure and in the management of complex patients, although the use of the pulmonary artery catheter is a monitoring procedure and not a treatment.
Subtotal intracardiac fragmentation of a pulmonary artery catheter during cardiac surgery: a rare complication of bipolar atrial ablation
TLDR
This is the first description of atrial high-frequency bipolar ablation associated with a nearly fatal damage of the PAC, and in a 67-year-old female patient with the diagnosis of an aortic and mitral valve stenosis and chronic atrial fibrillation, the PAC was recovered in total.
Perioperative haemodynamic therapy
TLDR
GDT provides a number of benefits in major surgery, including optimal haemodynamic performance, improves organ function, reduces the number of complications and time to ICU and hospital discharge and decreases the mortality rate in high-risk surgical patients.
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References

SHOWING 1-10 OF 66 REFERENCES
Use of pulmonary artery catheters in advanced heart failure
TLDR
There is no indication for routine use of pulmonary artery catheters to adjust therapy during hospitalization for decompensation of chronic heart failure, according to the results of the Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness and the meta-analysis.
The pulmonary artery catheter: In medio virtus
TLDR
There is a need to revisit the basics of hemodynamic management and reassess the way in which the pulmonary artery catheter is used, applying three key principles: correct measurement, correct data interpretation, and correct application.
Let us use the pulmonary artery catheter correctly and only when we need it
TLDR
A treatment protocol for the use of pulmonary artery catheter-derived variables is proposed that could serve as a basis for a prospective clinical trial and could improve patient-centered outcomes unless coupled with a treatment that improves outcome.
Which cardiac surgical patients can benefit from placement of a pulmonary artery catheter?
TLDR
This review highlights the specific role of PAC-derived haemodynamic data for each category of cardiac patients who can benefit from PAC monitoring and identifies five groups: patients with impaired left ventricular systolic function; those with impaired right ventricular diastolic dysfunction; thoseWith an acute ventricular septal defect; and those with aleft ventricular assist device.
Pulmonary artery catheterization in critically ill patients: A prospective analysis of outcome changes associated with catheter‐prompted changes in therapy
TLDR
Prompted by assessment of pulmonary artery catheter measurements in patients with circulatory shock who were unresponsive to standard therapeutic measures, a change in therapy for these patients was associated with an improved prognosis, independent of other variables influencing outcome.
A randomized, controlled trial of the use of pulmonary-artery catheters in high-risk surgical patients.
TLDR
No benefit to therapy directed by pulmonary-artery catheter over standard care in elderly, high-risk surgical patients requiring intensive care is found in this randomized trial comparing goal-directed therapy guided by a pulmonary-artership catheter with standard care without the use of a pulmonary.
Which general intensive care unit patients can benefit from placement of the pulmonary artery catheter?
TLDR
The present review focuses on safety and effectiveness data, with a special focus on reasonable indications for PAC use in the intensive care unit, taking into account the development of new technologies to measure cardiac output and stroke volume.
Insertion time of the pulmonary artery catheter in critically ill patients
TLDR
The pulmonary artery catheter use is time consuming, however, the availability and data collection intervals could be shortened.
Impact of pulmonary artery catheter in critically ill patients
TLDR
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.
A multicenter study of physicians' knowledge of the pulmonary artery catheter. Pulmonary Artery Catheter Study Group.
TLDR
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.
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