Lack of Effectiveness of the Pulmonary Artery Catheter in Cardiac Surgery

Schwann, Nanette M.; Hillel, Zak; Hoeft, Andreas; Barash, Paul G.; Möhnle, Patrick; Miao, Yinghui; Mangano, Dennis T.

doi:10.1213/ane.0b013e31822c94a8

Cited by 137 publications

(60 citation statements)

References 44 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Many post-cardiac surgery patients are being managed without a PA catheter or under “fast-track” protocols for early removal of PA catheters [1], however, CVP is typically able to be measured in these patients by way of a central venous catheter with its tip in the superior vena cava. The results of the present study indicate that CVP may be a useful predictor of patient outcome and the post-surgical patient with elevated CVP may warrant further workup to investigate the etiology (renal failure, pericardial tamponade, right heart failure, etc).…”

Section: Discussionmentioning

confidence: 99%

“…Many higher risk coronary artery bypass graft (CABG) surgery patients have a pulmonary artery catheter placed pre-operatively to help guide clinical management [1, 2]. Much attention is often paid to assuring patients’ have adequate cardiac output and index in the perioperative period.…”

mentioning

confidence: 99%

“…Much attention is often paid to assuring patients’ have adequate cardiac output and index in the perioperative period. However, central venous pressure (CVP) is another quick and simple hemodynamic parameter in the acute recovery period [1]. Despite its frequent measurement, the importance and role of CVP as a prognostic indicator has not received wide-spread study or attention.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Central venous pressure after coronary artery bypass surgery: Does it predict postoperative mortality or renal failure?

Williams

Peterson

Wojdyla

et al. 2014

Journal of Critical Care

View full text Add to dashboard Cite

Background While hemodynamic monitoring is often performed following coronary artery bypass grafting (CABG), the relationship between postoperative central venous pressure (CVP) measurement and clinical outcomes is unknown. Methods Detailed clinical data were analyzed from 2,390 randomly selected patients undergoing high risk CABG or CABG/valve at 55 hospitals participating in the Society of Thoracic Surgeons' National Cardiac Surgery Database from 2004 to 2005. Eligible patients underwent elective/urgent isolated CABG with an ejection fraction < 40%, or elective/urgent CABG at age ≥65 years with diabetes or a glomerular filtration rate 60 mL/min per 1.73 m2. Correlation between post-operative CVP and in-hospital / 30-day mortality and renal failure was assessed as a continuous variable, both unadjusted and after adjusting for important clinical factors using logistic regression modeling. Results Mean age was 72 years, 54% of patients had diabetes mellitus, 49% were urgent procedures, and mean cardiopulmonary bypass time was 105 minutes. Patients’ CVP 6 hours post-operation was strongly associated with in-hospital and 30 day mortality: odds ratio (OR) 1.5 (95% confidence interval [CI] 1.23, 1.87) for every 5 mmHg increase in CVP, p<0.0001. This association remained significant after risk-adjustment for cardiac index: adjusted OR 1.44 (95% CI 1.10, 1.89), p<0.01. A model adjusting for cardiac index also revealed increased incidence of mortality or renal failure: adjusted OR 1.5 (95% CI 1.28, 1.86) for every 5 mmHg increase in CVP, p<0.0001. Conclusion Patients’ central venous pressure at 6 hours following CABG surgery was highly predictive of operative mortality or renal failure, independent of cardiac index and other important clinical variables. Future studies will need to assess whether post-operative CVP can be used to guide intervention and improve outcomes.

show abstract

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

Central venous pressure after coronary artery bypass surgery: Does it predict postoperative mortality or renal failure?

Williams

Peterson

Wojdyla

et al. 2014

Journal of Critical Care

View full text Add to dashboard Cite

show abstract

“…The PAC, for the first time brought out anesthesiologists from operating rooms (ORs) to CCU; however, the perceived benefits of PAC did not last long and now various studies claim either no benefit or increased morbidity and mortality in critically ill patients with PAC. [7][8][9] The introduction of transesophageal echocardiography (TEE), particularly in cardiac anesthesia practice, has again put the anesthesiologists in the driver's seat. The TEE has given the status of diagnosticians to perioperative physicians; however, one should understand that this role comes with a great responsibility and accountability.…”

Section: My Journey As Chief Editor and Future Visionmentioning

confidence: 99%

My journey as chief editor and future vision

Neema

2014

Ann Card Anaesth

View full text Add to dashboard Cite

“…In a propensitymatched observational study involving 5,065 CABG patients from 70 centers, the use of a PAC during CABG surgery was associated with increased mortality and a higher risk of severe end-organ complications. [22] Failure to demonstrate improved clinical outcome with PAC may result from the lack of evidence-based treatments guided by PAC information. [23] New hemodynamic monitors have recently emerged (e.g., Esophageal Doppler and Pulse contour analysis), providing the ability to monitor CO noninvasively and to assess patient's responsiveness to fluid loading.…”

Section: Organizational Aspects and Human Factorsmentioning

confidence: 99%

Clinical Review: Management of weaning from cardiopulmonary bypass after cardiac surgery

Licker¹,

Diaper²,

Cartier³

et al. 2012

Ann Card Anaesth

View full text Add to dashboard Cite

A sizable number of cardiac surgical patients are difficult to wean off cardiopulmonary bypass (CPB) as a result of structural or functional cardiac abnormalities, vasoplegic syndrome, or ventricular dysfunction. In these cases, therapeutic decisions have to be taken quickly for successful separation from CPB. Various crisis management scenarios can be anticipated which emphasizes the importance of basic knowledge in applied cardiovascular physiology, knowledge of pathophysiology of the surgical lesions as well as leadership, and communication between multiple team members in a high-stakes environment. Since the mid-90s, transoesophageal echocardiography has provided an opportunity to assess the completeness of surgery, to identify abnormal circulatory conditions, and to guide specific medical and surgical interventions. However, because of the lack of evidence-based guidelines, there is a large variability regarding the use of cardiovascular drugs and mechanical circulatory support at the time of weaning from the CPB. This review presents key features for risk stratification and risk modulation as well as a standardized physiological approach to achieve successful weaning from CPB.

show abstract

Lack of Effectiveness of the Pulmonary Artery Catheter in Cardiac Surgery

Abstract: Use of a PAC during CABG surgery was associated with increased mortality and a higher risk of severe end-organ complications in this propensity-matched observational study. A randomized controlled trial with defined hemodynamic goals would be ideal to either confirm or refute our findings.

Cited by 137 publications

References 44 publications

Central venous pressure after coronary artery bypass surgery: Does it predict postoperative mortality or renal failure?

Central venous pressure after coronary artery bypass surgery: Does it predict postoperative mortality or renal failure?

My journey as chief editor and future vision

Clinical Review: Management of weaning from cardiopulmonary bypass after cardiac surgery

Contact Info

Product

Resources

About