The use of pulmonary artery catheters in intensive care: time for reappraisal?

The precise role of the pulmonary artery catheter (PAC) in reducing the morbidity and mortality of intensive care patients remains uncertain. Future studies of the different patient groups who possibly benefit from their use may well require multicentre trials in order to include sufficient numbers and produce significant conclusions. This would suggest a need for a consensus opinion on how PACs are actually used to obtain the different physiological variables which can influence patient management. A questionnaire was designed to assess the degree of conformity of PAC use in intensive care; the questions were derived from a Medline search and considered by the authors to represent a cross-section of the different aspects and potential errors of PAC use. A postal questionnaire was sent from a District General Hospital to 42 adult Intensive Care Units (ICUs) requesting information on the use of PACs in each ICU. The reply rate was 93%, with all but one of the respondents using PACs. The questionnaire obtained information in different areas of PAC use: 1. General usage of PACs. 2. Measurement of patient height and weight. 3. Confirmation of position of PAC tip. 4. Measurement of pulmonary artery wedge pressure (PAWP). 5. Measurement of cardiac output (CO). 6. Derived values. 7. Monitoring for PAC-related sepsis. The results of the questionnaire demonstrated a considerable lack of standardisation in the use of PACs in the United Kingdom.(ABSTRACT TRUNCATED AT 250 WORDS)