Pulmonary Artery Catheters Found Redundant

Simon Finfer, an associate professor and senior staff specialist, and Dr. Anthony Delaney, a senior lecturer and staff specialist, both of the intensive care unit at the Royal North Shore Hospital (Sydney, Australia) and the Northern Clinical School, University of Sydney (Australia), reviewed the evidence that these expensive devices actually help patients.

A recent health technology assessment in the United Kingdom reported that five large, randomized controlled trials all failed to show any clinical benefit of pulmonary artery catheters. 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. Given that the use of pulmonary artery catheters increases the risk of important complications, Drs. Finfer and Delaney claim that continued use of these devices is difficult to defend. An accompanying economic analysis concludes that if use of these catheters were discontinued, there would be a net mortality benefit at a rather modest cost.

"It seems now that proponents of using pulmonary artery catheters need to show that these devices' known risks are outweighed by their as-yet unproven benefits,” concluded the authors.

The Swan-Ganz pulmonary artery catheter was invented in 1968. Since then, catheterization has been part of the standard of care in the management of critically ill patients, enabling bedside monitoring by measuring heart output and capillary pressure in the lungs and becoming widely used in intensive care units.



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