Questionable Benefit of the Pulmonary Artery Catheter After Cardiac Surgery in High-Risk Patients

Chiang, Yu-Ting; Hosseinian, Leila; Rhee, Amanda J.; Itagaki, Shinobu; Cavallaro, Paul; Chikwe, Joanna

doi:10.1053/j.jvca.2014.07.017

Cited by 50 publications

(33 citation statements)

References 19 publications

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“…In trauma patients, PAC-guided therapy may benefit older, more severely injured patients, but use of a PAC is not associated with improved outcomes in other trauma populations. 8,9 Use of a PAC is not associated with improved outcomes in other populations, including high-risk cardiothoracic surgery 10 and general intensive care unit (ICU) patients, although many studies are more than 20 years old. 11 The addition of CVP monitoring to guided therapy is not associated with improved outcomes in patients with severe sepsis and septic shock.…”

Section: Aacn Practice Alertmentioning

confidence: 99%

Pulmonary Artery/Central Venous Pressure Monitoring in Adults

2016

Critical Care Nurse

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Section: Aacn Practice Alertmentioning

confidence: 99%

Pulmonary Artery/Central Venous Pressure Monitoring in Adults

2016

Critical Care Nurse

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“…Once considered essential for monitoring the cardiovascular status of the critically ill, the use of PAC has largely decreased in recent years [14]. Although there is general agreement that PAC should be reserved only for high-risk patients, such as those with severe pre-operative ventricular dysfunction or undergoing complex cardiac operations [15,16], a recent study questioned the benefits of PAC even in high-risk patients [17]. Nevertheless, a recent survey on the use of PAC in cardiac surgery showed that more than two-third of practitioners use PAC in over 75 % of patients [18].…”

Section: Discussionmentioning

confidence: 99%

Clinical practice in perioperative monitoring in adult cardiac surgery: is there a standard of care? Results from an national survey

Bignami¹,

Belletti²,

Moliterni

et al. 2015

J Clin Monit Comput

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This study was to investigate and define what is considered as a current clinical practice in hemodynamic monitoring and vasoactive medication use after cardiac surgery in Italy. A 33-item questionnaire was sent to all intensive care units (ICUs) admitting patients after cardiac surgery. 71 out of 92 identified centers (77.2 %) returned a completed questionnaire. Electrocardiogram, invasive blood pressure, central venous pressure, pulse oximetry, diuresis, body temperature and blood gas analysis were identified as routinely used hemodynamic monitoring, whereas advanced monitoring was performed with pulmonary artery catheter or echocardiography. Crystalloids were the fluids of choice for volume replacement (86.8 % of Centers). To guide volume management, central venous pressure (26.7 %) and invasive blood pressure (19.7 %) were the most frequently used parameters. Dobutamine was the first choice for treatment of left heart dysfunction (40 %) and epinephrine was the first choice for right heart dysfunction (26.8 %). Half of the Centers had an internal protocol for vasoactive drugs administration. Intra-aortic balloon pump and extra-corporeal membrane oxygenation were widely available among Cardiothoracic ICUs. Angiotensin-converting enzyme inhibitors were suspended in 28 % of the Centers. The survey shows what is considered as standard monitoring in Italian Cardiac ICUs. Standard, routinely used monitoring consists of ECG, SpO2, etCO2, invasive BP, CVP, diuresis, body temperature, and BGA. It also shows that there is large variability among the various Centers regarding hemodynamic monitoring of fluid therapy and inotropes administration. Further research is required to better standardize and define the indicators to improve the standards of intensive care after cardiac surgery among Italian cardiac ICUs.

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“…[21][22][23] This also holds true for the population of high-risk patients undergoing cardiac surgery, for which the PAC still is widely used. 24 That is slightly different from the transpulmonary thermodilution (TPTD) method, which, although invasive, only necessitates the insertion of a central venous line and an arterial thermistor catheter. 25 CO measured using this method might be considered interchangeable with that obtained by the gold standard (intermittent thermodilution with the PAC).…”

Section: Transition To Minimally Invasive and Noninvasive Hemodynamicmentioning

confidence: 99%

New Developments in Hemodynamic Monitoring

Scheeren

Ramsay

2019

Journal of Cardiothoracic and Vascular Anesthesia

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Hemodynamic monitoring is an essential part of the perioperative management of the cardiovascular patient. It helps to detect hemodynamic alterations, diagnose their underlying causes, and optimize oxygen delivery to the tissues. Furthermore, hemodynamic monitoring is necessary to evaluate the adequacy of therapeutic interventions such as volume expansion or vasoactive medications. Recent developments include the move from static to dynamic variables to assess conditions such as cardiac preload and fluid responsiveness and the transition to less-invasive or even noninvasive monitoring techniques, at least in the perioperative setting. This review describes the available techniques that currently are being used in the care of the cardiovascular patient and discusses their strengths and limitations. Even though the thermodilution method remains the gold standard for measuring cardiac output (CO), the use of the pulmonary artery catheter has declined over the last decades, even in the setting of cardiovascular anesthesia. The transpulmonary thermodilution method, in addition to accurately measuring CO, provides the user with some additional helpful variables, of which extravascular lung water is probably the most interesting. Less-invasive monitoring techniques use, for example, pulse contour analysis to originate flow-derived variables such as stroke volume and CO from the arterial pressure signal, or they may measure the velocity-time integral in the descending aorta to estimate the stroke volume, using, for example, the esophageal Doppler. Completely noninvasive methods such as the volume clamp method use finger cuffs to reconstruct the arterial pressure waveform, from which stroke volume and CO are calculated. All of these less-invasive CO monitoring devices have percentage errors around 40% compared with reference methods (thermodilution), meaning that the values are not interchangeable.

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Questionable Benefit of the Pulmonary Artery Catheter After Cardiac Surgery in High-Risk Patients

Cited by 50 publications

References 19 publications

Pulmonary Artery/Central Venous Pressure Monitoring in Adults

Pulmonary Artery/Central Venous Pressure Monitoring in Adults

Clinical practice in perioperative monitoring in adult cardiac surgery: is there a standard of care? Results from an national survey

New Developments in Hemodynamic Monitoring

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