Pulmonary artery catheters: Evolving rates and reasons for use*

Koo, Karen K. Y.; Sun, Jack; Zhou, Qi; Guyatt, G. H.; Cook, Deborah J.; Walter, Stephen D.; Meade, Maureen O.

doi:10.1097/ccm.0b013e318218a045

Cited by 87 publications

(46 citation statements)

References 29 publications

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“…The prevalence of PAC use in our study was higher than that published previously. In an assessment of trends on PAC use, Koo et al [11] showed the use of PAC in 45% of CS patients compared to the 64% in our registry.…”

Section: Discussionmentioning

confidence: 99%

“…Subsequently, randomized clinical trials (RCT) [5,6,7,8,9] and meta-analysis [10] failed to demonstrate any clinical benefit. Since then, its use has progressively declined [11,12]. It is now accepted that the routine use of PAC in critically ill patients is ineffective.…”

Section: Introductionmentioning

confidence: 99%

“…Nevertheless, PAC still has an important role in patients with acute heart failure and current guidelines suggest it should be considered for such patients who are persistently hypotensive [13,14,15]. Besides, in patients with cardiogenic shock (CS), PAC is still extensively used [11] and even recommended [2] to confirm the diagnosis and to guide changes in therapy. Despite this widespread practice, previous studies that investigated the effectiveness of PAC in critically ill patients did not specifically address its effect on patients with CS [6].…”

Section: Introductionmentioning

confidence: 99%

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Impact of Pulmonary Artery Catheter Use on Short- and Long-Term Mortality in Patients with Cardiogenic Shock

et al. 2016

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Objectives: The impact of pulmonary artery catheterization (PAC) on survival in patients with cardiogenic shock (CS) is not well established. This study aimed to assess whether Swan-Ganz catheter monitoring is related to short- and long-term mortality in patients with CS. Methods: One hundred and twenty-nine consecutive patients with a first admission for CS were prospectively enrolled in a single-center registry between December 2005 and May 2009, and were subsequently followed up over 5.3 years. Results: PAC was used in 64% of all patients with a mean age of 68 years (65% men). After adjustment for age, gender and the presence of CS upon admission, PAC was associated with lower short-term mortality [hazard ratio (HR) = 0.55, 95% confidence interval (CI) 0.35-0.86, p = 0.008] as well as lower mortality rates in the long-term follow-up (HR = 0.63, 95% CI 0.41-0.97, p = 0.035). In a subgroup analysis, the use of PAC was associated with reduced mortality in patients without acute coronary syndrome (ACS), i.e. 49% in the Swan-Ganz group vs. 82% (p = 0.010), but there was no difference within the ACS group. Conclusions: The use of PAC in patients with CS was associated with lower short- and long-term mortality rates after adjustment for age, gender and the presence of shock upon admission. This benefit was only significant in those patients without ACS.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Impact of Pulmonary Artery Catheter Use on Short- and Long-Term Mortality in Patients with Cardiogenic Shock

et al. 2016

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“…The results of the three efficacy trials failed to detect differences in benefit or harm (including mortality) in the PAC and comparator groups in the study populations. Taken together, the results of these three efficacy trials indicate that, under conditions in which patient selection is narrowly defined and appropriate placement and use of PAC is monitored and promoted, PACs did not lead to harm (49).…”

Section: Interpreting Results Of Efficacy and Effectiveness Studiesmentioning

confidence: 90%

An Official American Thoracic Society Research Statement: Comparative Effectiveness Research in Pulmonary, Critical Care, and Sleep Medicine

Carson¹,

Goss²,

Patel³

et al. 2013

Am J Respir Crit Care Med

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“…In this observational study the PAC was associated with an increased risk of mortality and increased resource use. A recent Canadian multicenter longitudinal randomized study has shown a 50% reduction in the rate of PAC use over 5 years [3] because PAC is invasive and is associated with various complications (infections, arrhythmias, thrombosis and pulmonary artery rupture) and financial costs [4]. The last decade was characterized by a growing interest in innovating, less invasive devices that could be substituted for the PAC.…”

Section: Introductionmentioning

confidence: 99%

Pulse waveform hemodynamic monitoring devices: recent advances and the place in goal-directed therapy in cardiac surgical patients

Hendy

Bubenek

2016

Rom J Anaesth Int Care

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Hemodynamic monitoring has evolved and improved greatly during the past decades as the medical approach has shifted from a static to a functional approach. The technological advances have led to innovating calibrated or not, but minimally invasive and noninvasive devices based on arterial pressure waveform (APW) analysis. This systematic clinical review outlines the physiologic rationale behind these recent technologies. We describe the strengths and the limitations of each method in terms of accuracy and precision of measuring the flow parameters (stroke volume, cardiac output) and dynamic parameters which predict the fluid responsiveness. We also analyzed the place of the APW monitoring devices in goaldirected therapy (GDT) protocols in cardiac surgical patients. According to the data from the three GDTrandomized control trials performed in cardiac surgery (using two types of APW techniques PiCCO and FloTrac/Vigileo), these devices did not demonstrate that they played a role in decreasing mortality, but only decreasing the ventilation time and the ICU and hospital length of stay.

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Pulmonary artery catheters: Evolving rates and reasons for use*

Cited by 87 publications

References 29 publications

Impact of Pulmonary Artery Catheter Use on Short- and Long-Term Mortality in Patients with Cardiogenic Shock

Impact of Pulmonary Artery Catheter Use on Short- and Long-Term Mortality in Patients with Cardiogenic Shock

An Official American Thoracic Society Research Statement: Comparative Effectiveness Research in Pulmonary, Critical Care, and Sleep Medicine

Pulse waveform hemodynamic monitoring devices: recent advances and the place in goal-directed therapy in cardiac surgical patients

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