Therapeutic Impact of Pulmonary Artery Catheterization in a Medical/Surgical ICU

Training is required to improve the reliability of esophageal doppler to measure cardiac output in critically ill patients

“…The impact of ED on decision making could be questioned. For instance, Steingrub et al [5] demonstrated that the knowledge of pulmonary artery catheter data leads to alteration in the therapeutic decision in about 50 % of patients. As echocardiography can assess left ventricular preload, afterload, and cardiac function, and diagnose valvular and aortic diseases [7,30,31], it probably influences decision making.…”

“…However, pulmonary artery catheterization may cause rare but serious complications and/or misinterpretations, especially for inexperienced operators [3][4][5]. Among noninvasive techniques used for CO measurement, ultrasonographic methods seem to be the most suitable in intensive care units [6,7].…”

Identifying patients with ARDS: time for a different approach

“…The fact that heart failure or volume overload can be evaluated (Figure 1) purely on clinical grounds (instead of objective ones) is also problematic, since it has been shown several times that physicians are notoriously poor at being able to estimate cardiac filling pressures in complicated, critically ill patients [24][25][26][27]. Finally, the algorithm in Figure 1 limits the classification of pulmonary edema to a simple dichotomy: one either has lung injury or one has a hydrostatic form of pulmonary edema; not both.…”

Evidenz-basierte Intensivmedizin

“…Wesentlich komplexer stellt sich die Evaluation des klinischen Nutzens oder Schadens eines invasiven Monitoringsystems dar. Die hämodyna-mische Messung mit dem PAK führt zunächst naturgemäß nicht zu einer Ände-rung der klinischen Situation (auch wenn die Messung mit dem PAK häufig Verän-derungen der Therapie nach sich ziehen [17,58,79] …”