The clinical use of the pulmonary artery catheter (PAC) has changed the modern practice of intensive care medicine. However, the effect of invasive haemodynamic monitoring on patient outcome remains uncertain. We report an unusual case of malposition of a PAC in the left internal mammary vein and we discuss the role of this monitor in the intensive care setting. Overall, the literature does not suggest a positive effect of PAC use on patient outcome. It has been suggested that PAC insertion may be of little benefit unless linked to specific therapies which may alter outcome. It is essential to understand the capabilities and limitations of the PAC in order to minimise potential complications and maximise benefits.
MurdochSDCohenATBellamyMC. Pulmonary artery catheterization and mortality in critically ill patients. Br J Anaesth2000;85: 611–15.
2.
HadianMPinskyMR. Evidence-based review of the use of the pulmonary artery catheter: impact data and complications. Crit Care2006;10 Suppl 3:S8.
3.
EshkevariLBakerBM. Occurrence and removal of a knotted pulmonary artery catheter: a case report. AANA J2007;75: 423–28.
4.
SchummerWSchummerCReinholdL. Differential diagnosis of left-sided thoracic venous catheters: case report of a persistent left superior vena cava. Der Anaesthetist2002;51: 726–30.
5.
GodwingJDChenJTT. Thoracic venous anatomy. Am J Roentgenol1986;147: 674–84.
6.
SarnakMJLeveyAS. Placement of an internal jugular dialysis catheter into the superior intercostal vein. Nephrol Dial Transplant1999;14: 2028–29.
7.
TenaaBGomarCRouxC. Serious mechanical complications associated with pulmonary artery catheters in cardiovascular and thoracic surgery. Rev Esp Anestesiol Reanim2008;55: 487–92.
8.
VincentJLPinskyMRSprungCL. The pulmonary artery catheter: in medio virtus. Crit Care Med2008;36: 3093–96.
9.
ShahMRHasselbladVStevensonLW. Impact of the pulmonary artery catheter in critically ill patients: meta-analysis of randomized clinical trials. JAMA2005;294: 1664.
10.
MuellerHSChatterjeeKDavisKB. American College of Cardiology expert consensus document. Present use of bedside right heart catheterization in patients with cardiac disease. J Am Coll Cardiol1998;32: 840.
11.
HadianMPinskyMR. Evidence-based review of the use of the pulmonary artery catheter: impact data and complications. Crit Care2006;10 Suppl 3:S8.
12.
HarveySHarrisonDASingerMAshcroftJ. PAC-Man study collaboration: Assessment of the clinical effectiveness of pulmonary artery catheters in management of patients in intensive care (PAC-Man): a randomised controlled trial. Lancet2005;366: 435–36.
13.
BinanayCCaliffRMHasselbladV. Evaluation study of congestive heart failure and pulmonary artery catheterization effectiveness: the ESCAPE trial. JAMA2005;294: 1625–33.
14.
VenderJS. Pulmonary artery catheter utilization: the use, misuse, or abuse. J Cardiothorac Vasc Anesth2006;20: 295–99.
15.
WigfullJCohenA. Critical assessment of haemodynamic data. Contin Educ Anaes Crit Care Pain2005;5: 84–88.
16.
RichardCWarszawskiJAnguelN. Early use of the pulmonary artery catheter and outcomes in patients with shock and acute respiratory distress syndrome: a randomized controlled trial. JAMA2003;290: 2713–20.
17.
SandhamJDHullRDBrantRF. A randomized, controlled trial of the use of pulmonary-artery catheters in high-risk surgical patients. New Engl J Med2003;348: 5–14.
18.
ShahMRHasselbladVStevensonLW. Impact of the pulmonary artery catheter in critically ill patients: meta-analysis of randomized clinical trials. JAMA2005;294: 1664–70.
19.
WheelerAPBernardGRThompsonBTon behalf of the National Heart, Lung and Blood Institute Acute Respiratory Distress Syndrome Clinical Trial Network. Pulmonary-artery versus central venous catheter to guide treatment of acute lung injury. New Engl J Med2006;354: 2213–24.
20.
DjaianiGKarskiJYudinM. Clinical outcomes in patients undergoing elective coronary artery bypass graft surgery with and without utilization of pulmonary artery catheter-generated data. J Cardiothorac Vasc Anesth2006;20: 307–10.
21.
HarveySYoungDBramptonW. Pulmonary artery catheters for adult patients in intensive care. Cochrane Database of Systematic Reviews2006; 3: Art. No.:CD003408. DOI: 10.1002/14651858.CD003408.pub2.
22.
ChittockDRDhingraVKRoncoJJ. Severity of illness and risk of death associated with pulmonary artery catheter use. Crit Care Med2004;32: 911–15.
23.
FrieseRSShafiSGentilelloLM. Pulmonary artery catheter use is associated with reduced mortality in severely injured patients: a national trauma data bank analysis of 53,312 patients. Crit Care Med2006;34: 1597–01.
24.
GreenbergSMurphyGVenderJ. Current use of the pulmonary artery catheter. Curr Opin Crit Care2009;15: 249–53.
25.
ChatterjeeK. The Swan-Ganz catheters: past, present, and future. A viewpoint. Circulation2009;119: 147–52.
26.
SakrYVincentJLReinhartK. Use of the pulmonary artery catheter is not associated with worse outcome in the ICU. Chest2005;1282722–31.
