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Pulmonary artery catheters in cardiovascular disease
1Section of Critical Care Medicine, Rush-Presbyterian-St. Luke's Medical Center, Chicago, IL 60612, USA.
Insights
Pulmonary artery catheter (PAC) use in cardiovascular disease can improve patient outcomes, particularly in acute myocardial infarction, heart failure, and shock. While not always proven by mortality trials, PACs aid rapid diagnosis and reduce intensive care stays.
Area of Science:
- Cardiology
- Critical Care Medicine
- Medical Device Technology
Background:
- The clinical utility of the pulmonary artery catheter (PAC) in cardiovascular disease management has been debated.
- While PACs guide therapeutic changes, robust evidence from prospective trials on hard outcomes is limited.
Purpose of the Study:
- To review the literature on the use of PACs in patients with cardiovascular disease.
- To evaluate the impact of PAC use on patient therapy and outcomes.
Main Methods:
- Literature search of English language articles from 1976-1996.
- Inclusion of studies and reviews on PAC use in cardiovascular disease.
- Extraction of data on therapy and outcome changes associated with PAC use.
Main Results:
- PACs prompt therapeutic changes in many cardiovascular patients.
- Evidence suggests PAC management improves outcomes in specific populations: acute myocardial infarction with complications, refractory congestive heart failure, pulmonary hypertension, and shock/hemodynamic instability.
- Most outcome data are retrospective; prospective randomized trials are lacking.
Conclusions:
- Pulmonary artery catheterization is valuable for optimizing patient management in cardiovascular disease.
- While not always demonstrating improved mortality in prospective trials, PAC use facilitates faster diagnosis and therapeutic goal achievement, reducing morbidity and intensive care unit days.
Objective:
To review the literature addressing the use of the pulmonary artery catheter (PAC) in patients with cardiovascular disease.
Data Source:
All pertinent English language articles dealing with pulmonary artery catheterization in patients with cardiovascular disease were retrieved from 1976 through 1996.
Study Selection:
Articles were chosen for review if the use of pulmonary artery catheterization in patients with cardiovascular disease was studied or reviewed.
Data Extraction:
From the articles selected, information was obtained about changes in therapy and changes in outcome associated with PAC use in patients with cardiovascular disease.
Data Synthesis:
Whether enhanced understanding of patient hemodynamics translates into definable benefits for those patients has recently come into question. Although there are a number of conventional clinical indications for pulmonary artery catheterization, and several studies have shown that catheterization prompts changes in therapy in many patients, most data regarding outcomes are retrospective; prospective randomized trials are lacking. Nonetheless, we believe, based on the available evidence and the preponderance of expert opinion, that management with the PAC improves outcome in several patient populations. These populations include: a) patients with acute myocardial infarction either complicated by cardiogenic shock or progressive hypotension, or associated with mechanical complications; b) patients with congestive heart failure refractory to empiric therapy; c) patients with pulmonary hypertension; and d) patients with shock or hemodynamic instability.
Conclusion:
Pulmonary artery catheterization is often used to optimize patient management, although this may not be demonstrable in terms of prospective trials using mortality or other "hard" outcome measures. Nonetheless, more rapid diagnosis and achievement of therapeutic endpoints guided by PAC use can decrease morbidity and intensive care days.