The pulmonary artery catheter in critically ill patients. Does it change outcome?

Initially described more than 30 years ago, the Pulmonary Artery Catheter (PAC) technique was becoming more and more used in the following years. This hemodynamic monitoring device can be used according 2 different therapeutic attitudes. The first one strives to achieve supranormal hemodynamic values, particularly in terms of cardiac index and oxygen consumption. However, this attitude has been demonstrated to be deleterious in the intensive care setting and is, to date, strongly questioned in the perioperative period. Conversely, the use of PAC to optimize the hemodynamic status in an individualized manner appears more seductive, even if the impact of a therapeutic attitude guided by standardized protocols has never been investigated. Although the PAC affords a continuous monitoring of a large panel of hemodynamic data, including tissue oxygenation parameters and estimation of left cardiac filling pressures, some pitfalls may occur in the measurement as well as in the interpretation of the data. Furthermore, because it is an invasive procedure, the safety of the PAC has been seriously questioned for several years. However, the recent study of Richard and coworkers clearly demonstrated that the use of PAC was not responsible for increased mortality in severely ill patients with circulatory shock and/or acute respiratory distress syndrome. The development of educational programs would allow to improve the quality of the collection and interpretation of hemodynamic parameters with the hope to enhance the efficiency of the PAC for the management of critically ill patients.