The Role of Pulmonary Artery Catheterization in the Management of Cardiothoracic Surgical Patients

Abstract

Pulmonary artery catheterization (PAC) is a commonly used method for assessment of perfusion in critically ill patients, especially cardiothoracic surgical patients. A vast amount of clinical experience indicates that PAC provides clinicians with information about the cardiovas cular system that is otherwise not readily available at the bedside. This information is then used for the diagnosis of various hemodynamic abnormalities and subsequently to guide and judge the efficacy of thera peutic interventions. A number of small, but highly controlled, studies have suggested that outcome can be improved when data from PAC are used to guide therapy in a specific manner. Studies that have not defined specific treatment endpoints based on findings derived from PAC have failed to demonstrate outcome differences, especially when relatively small numbers of low-risk patients have been studied. A large number of other factors have precluded formal scientific validation of definitive outcome differences with PAC, and, until data are available from appropriately designed, ad equately powered trials without randomization break down, rigorous analysis of available data does not justify any immediate change in the use of PAC. Hemo dynamic monitoring with PAC remains an important aspect of care during and especially after major cardio vascular surgery, and selective use in high-risk patients appears to be the most prudent and cost-effective application of this technology.