[HSF] Pulmonary Artery Catheters !

[Donald Ross]

We use them routinely and for opcab I find them particularly useful  
for me to see whether the anaesthetist  has filled the patient  
sufficiently.
In general if the pad is <15 I wont proceed. On the other hand if it  
is in the 28-+ range and cannot be reduced my nitrates or other  
clever drugs I elect to do the case beating heart on pump. Using this  
algorithm about 5% go on pump electively and only 0.5% need urgent CPB.
Don
( I once did a locum in New Zealand where opcab was a novelty and all  
the case had PA caths, then I did a complicated bentall and on asking  
for the PA pressures when coming off, was greeted by blank stares. It  
appeared that they were in more fear of the opcab than complex valve  
surgery.)
em On 03/11/2006, at 11:34 PM, prasannasimha wrote:

> I use them selectively.
> I think what they are referring to is use in the medical ICU's  
> rather than cardiac surgical ICU's.
> There are now alternative methods like PICO etc which allow  
> estimation of CO so the use of CCO is lesser than before.
> Prasanna
>
> Nasser F. Abou'Seada wrote:
>> How frequently do members of the forum use PA Catheter ? -  
>> Comments ??
>>
>> NFA
>>
>> HEART CATHETERS DO NOT BENEFIT PATIENTS
>> (Editorial: Pulmonary artery catheters)
>> http://bmj.com/cgi/content/full/333/7575/930
>>
>>
>> Doctors should probably stop using pulmonary artery catheters  
>> because they
>> do not benefit patients, say doctors from Australia in this week's  
>> BMJ.
>> The pulmonary artery catheter was invented in 1968. It enabled  
>> bedside
>> monitoring in critically ill patients by measuring heart output and
>> capillary pressure in the lungs and became widely used in  
>> intensive care
>> units.
>> But reports of serious complications soon appeared and arguments  
>> for and
>> against its use have continued ever since.
>> The most recent evaluation, commissioned by the NHS Health Technology
>> Assessment (HTA) programme, found that pulmonary artery catheters  
>> do not
>> benefit patients and concluded that withdrawing them from UK  
>> intensive care
>> units would be cost effective.
>> Another recent trial in patients with acute lung injury confirmed  
>> these
>> findings, while an analysis of 13 trials reported no overall  
>> effect of using
>> these devices on mortality or length of hospital stay.
>> So what should clinicians do with all this information?
>> Given that the use of pulmonary artery catheters increases the  
>> risk of
>> important complications, continued use of these devices is  
>> difficult to
>> defend, say the authors.
>> The onus is now on the proponents of the pulmonary artery catheter  
>> and
>> related devices to limit their use to clinical trials and to show  
>> that
>> protocols based on such devices do benefit patients, they conclude.
>>
>>
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