The pulmonary artery catheter in 2008 – A (finally) maturing modality?

Abstract

The first description of the flow-directed pulmonary artery catheter (PAC) was published in the 1970s by Jeremy Swan and William Ganz. Ever since its clinical debut, many controversies surrounded the use of the PAC. Regardless of these controversies, the most fundamental issues surrounding this hemodynamic monitoring device remain unresolved, including the exact indications, contraindications, identification of patients who potentially benefit from this technology, and the way we interpret and use PAC-derived parameters. Despite recent intensification of attacks against the use of the PAC by its opponents, it seems overly harsh to discount a technology that might be beneficial in appropriately selected clinical situations, especially when considering the fact that our true knowledge of this technology is somewhat limited. In fact, the PAC may still play an important role considering the resurgence of the concepts of euvolemic resuscitation and hemodynamic sufficiency.Republished with Permission from: Stawicki SP, Prosciak MP. The pulmonary artery catheter in 2008 – a (finally) maturing modality? OPUS 12 Scientist 2008;2(4):5-9.

Malignant pleural disease

“…Maximum fluid removal is disputed, although current guidelines would recommend 1–1.5 L drainage at any one time, due to risk of re-expansion pulmonary oedema (RPO) [ 7 , 93 ]. RPO is a rare, potentially fatal complication that occurs after rapid re-expansion of the lung from a collapsed state secondary to pneumothorax or pleural effusion [ 94 ]. Clinical signs of RPO include anterior chest discomfort, dyspnoea and desaturation.…”

What′s New in Critical Illness and Injury Science? The continued search for the ideal hemodynamic monitoring device: Spending ourselves in a worthy cause and coming up short

“…pointed out, newer techniques other that CVP may be superior,[ 8 9 10 11 12 ] but may only be of use in certain patient populations and may not function effectively in all physiologic states. [ 9 11 13 14 ] If these methods of monitoring hemodynamic status and volume expansion are also disparate in their results and reproducibility, then there is much more work to be done in the evaluations of these methods regarding the physiologic information and clinical assistance these devices actually provide.…”