Assessment of the clinical effectiveness of pulmonary artery catheters in management of patients in intensive care (PAC-Man): a randomised controlled trial

Harvey, Sheila; Harrison, David A; Singer, Mervyn; Ashcroft, Joanne; Jones, Carys; Elbourne, Diana; Brampton, William; Williams, Dewi; Young, John; Rowan, Kathryn M

doi:10.1016/s0140-6736(05)67061-4

Cited by 971 publications

(489 citation statements)

References 22 publications

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“…3 Previous studies of PAC use in critical care patients have reported complications rates of 5% to 10% although these were high risk patients compared to our group. 4,5 A large 5-year evaluation of RHC in patients with PH (performed via IJV in 72.7% of cases) reported 76 serious adverse events with 4 fatalities and 5 pneumothoraxes. 6 One patient died of a massive pulmonary embolism immediately prior to RHC, 5 days after discontinuation of warfarin therapy for the procedure.…”

Section: Discussionmentioning

confidence: 99%

A Retrospective Review to Evaluate the Safety of Right Heart Catheterization via the Internal Jugular Vein in the Assessment of Pulmonary Hypertension

Ranu¹,

Smith²,

Nimako³

et al. 2010

Clinical Cardiology

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was performed. We do not routinely use ultrasound guidance or stop anticoagulation. Operators with a median experience of 450 procedures performed the RHCs. Results: Right heart catheterization was performed on 349 patients with a median age of 66 years (range, 17-89), median mean pulmonary artery pressure of 30 mm Hg (range, 8-69), and a median internationalized normal ratio of 2.5. Of 349 patients, we were unable to obtain intravenous access in only 1 patient; 342 (98%) patients tolerated RHC with local anesthetic alone; and 6 patients required additional sedation with benzodiazepines. The median time for the procedure was 15 minutes. Complications occurred in 6 patients (1.7%) and included carotid puncture (n = 3), sinus bradycardia below 45 beats/min, which responded promptly to atropine and intravenous fluid (n = 2), and complete heart block without hemodynamic compromise (n = 1). There were no pneumothoraxes, pulmonary hemorrhage, or deaths related to the procedure. Conclusion: Right heart catheterization via the IJV is quick, safe, and well tolerated. It is not associated with an increased risk of pneumothorax or other complications when performed by experienced operators. IntroductionRight heart catheterization (RHC) using a pulmonary artery catheter (PAC) remains the gold standard in the diagnosis of pulmonary arterial hypertension (PAH). In addition to diagnosing PAH and assessing for potential reversibility, it can ascertain whether pulmonary hypertension (PH) is due to cardiac disease and can guide therapeutic intervention. Measurement of pulmonary hemodynamics is also required in patients being considered for cardiothoracic, and occasionally hepatic, transplantation. A percutaneous femoral vein approach is more commonly used in some centers. Less commonly, an internal jugular vein (IJV) approach is used which may reflect concerns regarding risks associated with this site of access. We describe our experience of RHC performed via the IJV at a tertiary center for cardiothoracic medicine.

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Section: Discussionmentioning

confidence: 99%

A Retrospective Review to Evaluate the Safety of Right Heart Catheterization via the Internal Jugular Vein in the Assessment of Pulmonary Hypertension

Ranu¹,

Smith²,

Nimako³

et al. 2010

Clinical Cardiology

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“…We have also demonstrated that increased pulmonary oedema is associated with reduced survival in patients with ALI (Craig, Duffy et al 2009). In ALI patients with a markedly elevated dead space fraction has been identified as an independent predictor of mortality [21]. A significant fraction of the elevation in pulmonary dead space fraction is probably explained by lung vascular injury mediated via this pro-inflammatory cascade.…”

Section: Mechanisms Of Alimentioning

confidence: 99%

Keratinocyte growth factor for the treatment of the acute respiratory distress syndrome (KARE): a randomised, double-blind, placebo-controlled phase 2 trial

McAuley

Cross

Hamid

et al. 2017

The Lancet Respiratory Medicine

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“…18,19 The development of alternative less-invasive means of measuring cardiac output (e.g., esophageal Doppler), a shift of focus from cardiac output to volume status optimization, and a series of prospective randomized controlled trials that failed to show improvements in mortality when applied to critically ill patients, [20][21][22] have precluded the PAC from use in ERAS protocols. For these reasons, PACs are not further addressed in this review.…”

Section: Pulmonary Artery Cathetermentioning

confidence: 99%

Inter-device differences in monitoring for goal-directed fluid therapy

Thiele

Bartels

Gan

2014

Can J Anesth/J Can Anesth

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Assessment of the clinical effectiveness of pulmonary artery catheters in management of patients in intensive care (PAC-Man): a randomised controlled trial

Cited by 971 publications

References 22 publications

A Retrospective Review to Evaluate the Safety of Right Heart Catheterization via the Internal Jugular Vein in the Assessment of Pulmonary Hypertension

A Retrospective Review to Evaluate the Safety of Right Heart Catheterization via the Internal Jugular Vein in the Assessment of Pulmonary Hypertension

Keratinocyte growth factor for the treatment of the acute respiratory distress syndrome (KARE): a randomised, double-blind, placebo-controlled phase 2 trial

Inter-device differences in monitoring for goal-directed fluid therapy

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