Impact of the Pulmonary Artery Catheter in Critically Ill Patients

Abstract

HE PULMONARY ARTERY CATHeter (PAC) is used to diagnose various diseases and physiological states, monitor the progress of critically ill patients, and guide the selection and adjustment of medical therapy. 1 The PAC is often considered a cornerstone of critical care and a hallmark of the intensive care unit (ICU). 2 Approximately 1 million PACs are used annually in the United States. 3 However, despite widespread use of these devices, there are conflicting data about their utility. The majority of nonrandomized studies in critically ill patients have suggested that the PAC is associated with increased morbidity and mortality. 4 Conversely, some nonrandomized studies have shown improved quality of life when the PAC was used to direct a specific therapeutic approach. [5][6][7] Since the mid-1980s, randomized clinical trials (RCTs) have been conducted to evaluate the efficacy of the PAC. However, none of these trials have been persuasive individually, because See also pp 1625 and 1693.

Survival by Dialysis Modality in Critically Ill Patients with Acute Kidney Injury

“…Recent examples include the use of PA catheters in the ICU (41,42), the use of certain antiarrhythmic agents in an attempt to prevent sudden cardiac death (43), and the use of selected inotropes and vasodilators in the treatment of congestive heart failure (44). When the results of the current observational study on dialysis-requiring AKI in the ICU are integrated with other observational studies and clinical trials, there is no evidence of the superiority of CRRT over IHD and some evidence to support possible inferiority.…”

Plasma NT-proBNP as a More Reliable Biomarker of Endogenous Cardiac Natriuretic Peptides Than BNP During Carperitide Infusion

“…[1][2][3][4] Several clinical studies have demonstrated that plasma levels of BNP and NT-proBNP are useful biomarkers to evaluate the severity and the prognosis of patients with heart failure. [5][6][7] Evaluation of the left ventricular filling pressure or pulmonary capillary wedge pressure is important, especially in patients with severe heart failure, however, direct hemodynamic measurements by Swan-Ganz catheters have not been regularly performed [8][9][10][11] and it has been often estimated by the plasma levels of ANP, BNP, and NT-proBNP and these peptides demonstrate almost equal values under various treatments for heart failure. [12][13][14][15][16] Because two endogenous natriuretic peptides, ANP and BNP, bind to natriuretic peptide receptors (NPR); NPR-A and NRP-C receptors with a relatively higher selectivity for ANP than BNP, 17,18) plasma levels of BNP may be affected by carperitide (ANP) infusion.…”

Perioperative Management of Adrenalectomy and Inferior Vena Cava Reconstruction in a Patient With a Large, Malignant Pheochromocytoma With Vena Caval Extension

“…A meta-analysis (n ¼ 5,051, 13 randomized controlled trials) showed no benefit in mortality, number of days hospitalized, inotrope exposure, or vasodilator therapy when using a pulmonary arterial catheter for critically ill patients in the ICU. 76 Direct cardiac imaging using TEE frequently can bypass these limitations. 73,74 Several studies suggested TEE may be beneficial in noncardiac surgical patients with hemodynamic instability, explaining its strong endorsement for this setting in recent guidelines.…”