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September 18, 1996JAMA

Is It Time to Pull the Pulmonary Artery Catheter?

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Key result

Pulmonary artery catheterization lacks evidence of benefit for decreasing patient morbidity or mortality, and may actually increase these outcomes despite widespread use.

Why the study?

Does pulmonary artery catheterization improve morbidity or mortality in critically ill and/or hemodynamically unstable patients?

Population

Critically ill and/or hemodynamically unstable patients, including those with acute myocardial infarction…

Design

Editorial

Authors

JDJames E. DalenGeneral Cardiology

Discussion

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Overview

Routine use should not yet change practice in critically ill patients; leaves open the need for definitive randomized trials in select subgroups.

Key Points

  • Evaluate the clinical evidence, safety outcomes, and economic impact of widespread pulmonary artery catheterization in critically ill patients.
  • Assessed utilization rates, healthcare expenditures, and outcome literature regarding pulmonary artery catheterization across intensive care and perioperative settings.
  • More than 1 million pulmonary artery catheters are used annually in the United States, generating healthcare expenditures exceeding $2 billion per year.
  • Pulmonary artery catheterization provides no evidence of reduced morbidity or mortality across indications such as acute myocardial infarction and congestive heart failure, with data suggesting potential increases in adverse outcomes.

Structured PICO

Does pulmonary artery catheterization improve morbidity or mortality in critically ill and/or hemodynamically unstable patients?

P
Population
Critically ill and/or hemodynamically unstable patients, including those with acute myocardial infarction, congestive heart failure, multiorgan failure, and patients with heart disease undergoing cardiac or noncardiac surgery.
I
Intervention
Pulmonary artery catheterization
O
Outcome
Patient morbidity or mortalityhard clinical

Despite widespread use and high costs, routine pulmonary artery catheterization in critically ill patients lacks evidence of benefit and may be associated with increased morbidity and mortality.

Cite This Study

James E. Dalen (1996) conducted an editorial in Critically ill and/or hemodynamically unstable patients. Pulmonary artery catheterization was evaluated on Patient morbidity or mortality. Pulmonary artery catheterization lacks evidence of benefit for decreasing patient morbidity or mortality, and may actually increase these outcomes despite widespread use.

synapsesocial.com/papers/6a0980d116dfdfe7ed34261ehttps://doi.org/10.1001/jama.1996.03540110070035
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1STUDIES OF CONGENITAL HEART DISEASE. II. THE PRESSURE AND OXYGEN CONTENT OF BLOOD IN THE RIGHT AURICLE, RIGHT VENTRICLE, AND PULMONARY ARTERY IN CONTROL PATIENTS, WITH OBSERVATIONS ON THE OXYGEN SATURATION AND SOURCE OF PULMONARY “CAPILLARY” BLOOD 11947 · 143 citations
  2. 2STUDIES OF CONGENITAL HEART DISEASE. I. TECHNIQUE OF VENOUS CATHETERIZATION AS A DIAGNOSTIC PROCEDURE 11947 · 112 citations
  3. 3Catheterization of the Heart in Man with Use of a Flow-Directed Balloon-Tipped Catheter1970 · 2,146 citations
  4. 4A Randomized Control Trial of Right-Heart Catheterization in Critically Ill Patients1991 · 159 citations
  5. 5Flow-directed Pulmonary Artery Catheterization1989 · 20 citations