[HSF] Pulmonary Artery Catheters ! [OT]

Fri Nov 3 17:43:04 EST 2006

> I'll then soundly chastise the anesthesiologist
> (usually new) so that they know just how dangerous a situation this can
be.
> Hal" 

aha ... I can see ... having known that Hal has never been to where I've had
my residency ....  The probability arises that that "big head-BANG" across
the BBB essentially originated somewhere in Arkansas ..!!!

NFA

> From: hgrmd at aol.com
> Don,
>   I totally agree and should have also mentioned that I always want the
> anesthesiologist to position the tip of the Swan just after the pulmonary
valve.  I
> never want to see the wedge, ever.  Even so, I occasionally will notice
the Swan has
> migrated into the wedge position.  I'll then soundly chastise the
anesthesiologist
> (usually new) so that they know just how dangerous a situation this can
be.
> Hal

> From: donross at bigpond.com
> This is a complication from which we have had fatal outcomes as well.
> Since putting in strict rules prohibiting the performance of wedge
pressures on
> heparinised patients there have been no more such incidents.
> In my patients, wedge pressure measurements are totally forbidden.
> Don
> On 04/11/2006, at 7:03 AM, Salerno, Tomas wrote:
> 
> > This is the Abstract on our paper:
> >
> >
> > Massive endobronchial hemorrhage due to balloon-tipped catheter >
rupture of a
> branch of the pulmonary artery in a fully heparinized > patient undergoing
> cardiopulmonary bypass is potentially lethal. > Death occurs due to
asphyxiation.
> Endobronchial intubation (double-> lumen endotracheal tube) appears to be
a simple
> and effective > method for control of the airway and tamponade of the
bleeding >
> site, which allows for completion of the surgical procedure until >
protamine sulphate
> reversal can be achieved.
> >
> >
> >
> > Tomas
> >
> > PMID: 6830370 [PubMed - indexed for MEDLINE
> > -----Original Message-----
> > From: openheart-l-bounces at lists.hsforum.com [mailto:openheart-l->
> bounces at lists.hsforum.com] On Behalf Of prasannasimha
> > Sent: Friday, November 03, 2006 12:27 PM
> > To: OpenHeart-L at lists.hsforum.com
> > Subject: Re: [HSF] Pulmonary Artery Catheters !
> >
> > Not available online. Can you send the article to my email.
> > What is the summary of the paper ?
> > Prasanna
> >
> > Salerno, Tomas wrote:
> >> We reported on this subject:
> >>
> >> Cervenko FW, Shelley SE, Spence DG, Charrette EJP, Salerno TA: >>
Massive
> endobronchial hemorrhage during cardiopulmonary bypass: >> Treatable
> complication of bloon-tipped catheter damage to the >> pulmonary artery.
> >> Ann Thorac Surg 1983; 35: pp 326-328
> >>
> >> Tomas
> >>
> >> -----Original Message-----
> >> From: openheart-l-bounces at lists.hsforum.com [mailto:openheart-l->>
> bounces at lists.hsforum.com] On Behalf Of Dr. Roberto Battellini
> >> Sent: Friday, November 03, 2006 12:01 PM
> >> To: OpenHeart-L at lists.hsforum.com
> >> Subject: AW: [HSF] Pulmonary Artery Catheters !
> >>
> >> As less as possible. We had here 2 cases in the last 5 years of >>
perforation
> >> of the pulmonary arteries and terrible intrapulmonary bleeding, >> they
finally
> >> died. One of them was a case of mine, 80 years old, needed right
> >> pneumonectomy...game over--> for Wikipedia
> >> Roberto
> >>
> >> -----Ursprüngliche Nachricht-----
> >> Von: openheart-l-bounces at lists.hsforum.com
> >> [mailto:openheart-l-bounces at lists.hsforum.com] Im Auftrag von >> Nasser
F.
> >> Abou'Seada
> >> Gesendet: Freitag, 3. November 2006 11:30
> >> An: OpenHeart-L at lists.hsforum.com
> >> Betreff: RE: [HSF] Pulmonary Artery Catheters !
> >>
> >> 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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