Analysis of Flow-Directed Pulmonary Artery Catheterization

NOT ALL the maneuvers directed toward benefiting patients necessarily result innetbenefit—a situation we readily accept in conscientiously attempting to avoid the toxic effects, complications, and side effects of medical and surgical treatments. Yet, like treatments, invasive diagnostic procedures present complications and side effects that may be less comprehensively appreciated. In this issue ofThe Journal, Carlson and colleagues1report pulmonary artery hemorrhage, a rare complication of flow-directed pulmonary artery catheterization, in three patients, one of whom was adroitly treated with therapeutic embolism. While the authors list risk factors for this complication (to which could be added recent cardiopulmonary bypass), their report should be considered in a broader context—that of indications for catheterization and the panoply of recognized complications, summarized in the Table, as well as the poorly understood physiological burden imposed by the presence of intravascular instrumentation itself.2 Recognized Complications The precise incidence of recognizable complications