Pros and cons of pulmonary artery catheterization in the critically ill

It is evident that the pulmonary artery catheter has provided detailed insight into hemodynamic and metabolic disturbances in the critically ill ( GrO®D®y.e.!d §D.d...Xh.iis... 1991). However, it is less clear whether catheterization should be performed in every patient with cardiopulmonary compromise. The impact of a pulmonary artery catheter and the hemodynamic variables obtained with it on management and outcome are not well defined, and the benefits may not outweigh the risks of catheter insertion. Moreover, understanding of the pulmonary artery catheter varies widely among doctors and nurses, emphasizing the need for continuous education on its role in hemodynamic monitoring.

Investigators favoring liberal use argue that failure of clinical judgment in diagnosing shock or instituting successful treatment is an indication for catheterization, since continuous assessment of essential hemodynamic and metabolic variables reflecting the type, severity, and course of circulatory compromise is needed to ensure immediate adjustment of therapy. In fact, delay in appropriate treatment is one of the most important factors associated with mortality in shock. Proponents further argue that clinical judgment and estimation of circulatory status often fail to predict cardiac filling, output, and function (and derived vascular resistances) in critically ill patients. The introduction of the pulmonary artery catheter by experienced critical care physicians may improve outcome in a variety of specialty units and patient conditions. With careful attention to the technique, insertion of a pulmonary artery catheter is relatively safe and the complication rate decreases with increasing experience.

Investigators who do not favor widespread use of pulmonary artery catheterization claim that clinical judgment is not inferior to invasive assessment of cardiac output. There is controversy concerning the prognostic significance of hemodynamic and metabolic disturbances in shock other than those associated with myocardial infarction. There is little direct (as opposed to circumstantial) evidence that invasive hemodynamic monitoring improves outcome in shock, even when hemodynamic data lead to alterations in therapy.

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