The contemporary pulmonary artery catheter. Part 1: placement and waveform analysis

Area of Science:

• Cardiovascular Medicine
• Critical Care
• Medical Devices

Background:

• The pulmonary artery catheter (PAC) has been used for hemodynamic monitoring for nearly 50 years.
• Contemporary PACs offer continuous data on cardiac output, oxygen balance, and right ventricular performance, evolving from intermittent measurement devices.

Purpose of the Study:

• To review the evolution of the PAC from intermittent to continuous monitoring.
• To detail the insertion techniques, waveform interpretation, and associated pitfalls of PAC use.
• To discuss the measurements provided by contemporary PACs, including limitations.

Main Methods:

• This review is presented in two parts.
• Part one focuses on PAC insertion, waveform analysis, and respiratory interactions.
• Part two will cover continuous cardiac output, RV ejection fraction, and mixed venous oxygen saturation measurements.

Main Results:

• The review differentiates between intermittent thermodilution and continuous PAC measurements.
• It highlights the importance of understanding PAC waveforms and their interaction with the respiratory cycle.
• Potential pitfalls in waveform analysis are discussed.

Conclusions:

• A thorough understanding of PAC measurements is essential for successful clinical practice.
• The review aims to equip clinicians with the knowledge to effectively utilize contemporary PAC technology.
• This work serves as a foundational guide for PAC application in daily practice.