A prospective randomized trial of preoperative “optimization” of cardiac function in patients undergoing elective peripheral vascular surgery

I Diretriz Latino-Americana para avaliação e conduta na insuficiência cardíaca descompensada

“…Different prospective studies have evaluated the efficacy of invasive monitoring of the pulmonary artery in high risk surgical patients [150][151][152] . There were no differences among the patients who received therapy guided by parameters offered by the pulmonary artery catheter and the patients with a clinical follow-up.…”

The Effects of Fluid Optimization on Outcome Following Major Surgery

“…One trial involving patients presenting for aortic or lower limb arterial surgery failed to demonstrate a significant morbidity or mortality difference between control and protocol groups. 37 However, a large study of patients undergoing elective coronary revascularization with cardiopulmonary bypass demonstrated a significant reduction in length of stay in those randomized to maintenance of SvO2 > 70% and lactate < 2 mmol/L. 38 The goal-directed studies discussed thus far all used flow goals measured with a pulmonary artery catheter (PAC).…”

Pulmonary artery catheters in cardiovascular surgery

“…7 In two other small RCTs of patients undergoing elective vascular surgery (some undergoing AAR) the PAC was used to guide therapy aimed at "optimizing" oxygen delivery. 8,9 These studies also showed no improvement in outcome associated with the PAC. Cardiovascular anesthesiologists may also have been swayed by the results of uncontrolled, observational studies in which PAC use has been associated with increased mortality and resource utilization in various patient populations including those with complicated myocardial infarction, 10 critical illness, 1 1 or undergoing noncardiac surgery.…”