Pulmonary Artery Catheters for Adult Patients in Intensive Care

Cooper, Adam S.

doi:10.4037/ccn2016883

Cited by 2 publications

(2 citation statements)

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“…[17] One recent trend in critical care medicine is the abandonment of invasive hemodynamic monitoring tools, such as the PAC, in favor of minimally or noninvasive substitutes. [1819] The rationale behind this trend is two-fold: (a) elimination of complications associated with invasive hemodynamic monitoring tools;[220] and (b) lack of clinical evidence supporting the use of invasive modalities outside of narrowly defined, often specialized indications. [321]…”

Section: Discussionmentioning

confidence: 99%

Correlations between pulmonary artery pressures and inferior vena cava collapsibility in critically ill surgical patients: An exploratory study

Stawicki

Papadimos

Bahner

et al. 2016

Int J Crit Illn Inj Sci

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Introduction:As pulmonary artery catheter (PAC) use declines, search continues for reliable and readily accessible minimally invasive hemodynamic monitoring alternatives. Although the correlation between inferior vena cava collapsibility index (IVC-CI) and central venous pressures (CVP) has been described previously, little information exists regarding the relationship between IVC-CI and pulmonary artery pressures (PAPs). The goal of this study is to bridge this important knowledge gap. We hypothesized that there would be an inverse correlation between IVC-CI and PAPs.Methods:A post hoc analysis of prospectively collected hemodynamic data was performed, examining correlations between IVC-CI and PAPs in a convenience sample of adult Surgical Intensive Care Unit patients. Concurrent measurements of IVC-CI and pulmonary arterial systolic (PAS), pulmonary arterial diastolic (PAD), and pulmonary arterial mean (PAM) pressures were performed. IVC-CI was calculated as ([IVCmax − IVCmin]/IVCmax) × 100%. Vena cava measurements were obtained by ultrasound–credentialed providers. For the purpose of correlative analysis, PAP measurements (PAS, PAD, and PAM) were grouped by terciles while the IVC-CI spectrum was divided into thirds (<33, 33–65, ≥66).Results:Data from 34 patients (12 women, 22 men, with median age of 59.5 years) were analyzed. Median Acute Physiologic Assessment and Chronic Health Evaluation II score was 9. A total of 76 measurement pairs were recorded, with 57% (43/76) obtained in mechanically ventilated patients. Correlations between IVC-CI and PAS (rs = −0.334), PAD (rs = −0.305), and PAM (rs = −0.329) were poor. Correlations were higher between CVP and PAS (R2 = 0.61), PAD (R2 = 0.68), and PAM (R2 = 0.70). High IVC-CI values (≥66%) consistently correlated with measurements in the lowest PAP ranges. Across all PAP groups (PAS, PAD, and PAM), there were no differences between the mean measurement values for the lower and middle IVC-CI ranges (0%-65%). However, all three groups had significantly lower mean measurement values for the ≥66% IVC-CI group.Conclusions:Low PAS, PAD, and PAM measurements show a reasonable correlation with high IVC-CI (≥66%). These findings are consistent with previous descriptions of the relationship between IVC-CI and CVP. Additional research in this area is warranted to better describe the hemodynamic relationship between IVC-CI and PAPs, with the goal of further reduction in the reliance on the use of PACs.

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Section: Discussionmentioning

confidence: 99%

Correlations between pulmonary artery pressures and inferior vena cava collapsibility in critically ill surgical patients: An exploratory study

Stawicki

Papadimos

Bahner

et al. 2016

Int J Crit Illn Inj Sci

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“…However, nurses should also take note of evidence regarding the cumulative value of ‘little’ details. For example, recent research indicates that keeping a patient's mouth clean is more likely to save the patient's life than is adjusting care according to pulmonary artery wedge pressure readings (Cooper, ; Hoshijima et al., ; Maeda & Akagi, ).…”

Section: Implications For Current Practicementioning

confidence: 99%

Crisis at Guy's Hospital (1880) and the nature of nursing work

2017

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This historical study aims to refine understanding of the nature of nursing work. The study focuses on the 1880 crisis at Guy's Hospital in London to examine the nature and meaning of nursing work, particularly the concept of nursing work as many 'little things.' In this paper, an examination of Margaret Lonsdale's writing offers an original contribution to our understanding of the ways in which nursing work differs from medical practice. In this way, we use the late-nineteenth-century controversy at Guy's Hospital as a prism through which to examine the contested nature of nursing work. Lonsdale's ideas are corroborated by examination of writings by nurse leaders Florence Nightingale and Eva Luckes. Luckes, in particular, elaborated what was meant by nursing as the performance of a thousand little things, which are specific to nursing work. While physicians had been performing much of what was considered to be nursing work, nurses developed some of these and other interventions into a unique body of work characterized by meticulous attention to significant details. Some implications regarding current nursing practice are discussed.

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Pulmonary Artery Catheters for Adult Patients in Intensive Care

Cited by 2 publications

References 1 publication

Correlations between pulmonary artery pressures and inferior vena cava collapsibility in critically ill surgical patients: An exploratory study

Correlations between pulmonary artery pressures and inferior vena cava collapsibility in critically ill surgical patients: An exploratory study

Crisis at Guy's Hospital (1880) and the nature of nursing work

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