Pulmonary artery catheters in cardiovascular disease

To review the literature addressing the use of the pulmonary artery catheter (PAC) in patients with cardiovascular disease.

All pertinent English language articles dealing with pulmonary artery catheterization in patients with cardiovascular disease were retrieved from 1976 through 1996.

Articles were chosen for review if the use of pulmonary artery catheterization in patients with cardiovascular disease was studied or reviewed.

From the articles selected, information was obtained about changes in therapy and changes in outcome associated with PAC use in patients with cardiovascular disease.

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.

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.