The Pulmonary Artery Catheter in 2015

Abstract

The pulmonary artery catheter (PAC) has revolutionized the care of critically ill patients by allowing physicians to directly measure important cardiovascular variables at the bedside. The relative ease of placement and the important physiological data obtained by PAC led to its incorporation as a central tool in the management of critically ill patients in intensive care units. Given the lack of demonstrable benefit in randomized clinical trials, persistent questions about safety, and recent advancements in noninvasive imaging modalities that purport to more accurately estimate cardiovascular hemodynamics, the use of the PAC has declined rapidly over recent years. Devised by cardiologists to measure hemodynamic parameters in patients with acute myocardial infarction, the PAC was quickly and enthusiastically adopted by intensivists, anesthesiologists, surgeons, and other specialists. This unbridled proliferation may have resulted in negative publicity surrounding the PAC. This article systematically reviews the evolution of PACs, the results of nonrandomized and randomized studies in various clinical conditions, the reasons for its decline, and current indications of PAC.

Contemporary perioperative haemodynamic monitoring

“…ScVO 2 became an interesting alternative in the management of patients with cardiac failure from what origin [40]. However, the clinical utility of PAC declined significantly from the end of the 90s because of the availability of alternative monitoring and the awareness of the potential of serious complications [41]. More recently, the PAC has been reserved for patients with hypoxia or acute pulmonary hypertension with overt right heart failure [42].…”

Perioperative anesthetic considerations in patients with pulmonary hypertension undergoing non-cardiac and non-obstetric surgeries

“…should be performed much less frequently because of its inconsistent results related to improved outcomes [13,39,40].…”

Focused Review of Perioperative Care of Patients with Pulmonary Hypertension and Proposal of a Perioperative Pathway

“…This monitor provides immediate feedback on hemodynamic changes and can alert to early warning signs of cardiovascular decompensation. Central lines, especially pulmonary artery catheters, have a relatively high complication rate and are placed much less frequently as they have not been shown to consistently improve outcomes [ 27 - 28 ]. The main advantage of central venous catheterization is the ability to have reliable access in order to administer high dose vasoactive medications.…”