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Pulmonary-Artery Catheters Not Beneficial in Patients with Shock or ARDS

Outcomes were similar for critically ill patients who did or did not receive Swan-Ganz catheters.

In a recent trial, the routine perioperative use of pulmonary-artery (PA) catheters did not benefit high-risk surgical patients (Journal Watch Jan 17 2003). Now, in a multicenter trial, investigators have examined the use of PA catheters in a different patient population.

French researchers enrolled 676 patients with early shock (mostly septic shock), acute respiratory distress syndrome (ARDS), or both; 84% were medical patients, and 16% were surgical patients. Patients were assigned randomly to receive PA catheters or no catheters; all patients received standard intensive care. Clinicians were given a set of general management principles but no specific treatment protocols. No significant differences were found between the 2 groups in mortality rate (at 14, 28, or 90 days), hospital or ICU lengths of stay, ventilator-free days, or extent of organ failure. No fatal complications of PA catheters were reported.

Comment: Once again, results from a randomized trial suggest that routine placement of PA catheters is not beneficial in a defined category of patients. One possible criticism of this study is that specific goal-directed therapies, based on catheter measurements, were not mandated for patients in the PA-catheter group. However, the recent surgical study mentioned above, which did incorporate goal-directed protocols, also failed to demonstrate improved outcomes with PA catheters. Additional randomized trials of PA catheters are ongoing in both the U.K. and the U.S.

— Allan S. Brett, MD

Published in Journal Watch General Medicine December 5, 2003

Citation(s):

Richard C et al. Early use of the pulmonary artery catheter and outcomes in patients with shock and acute respiratory distress syndrome: A randomized controlled trial. JAMA 2003 Nov 26; 290:2713-20.

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• Medline abstract (Free)

Fowler RA and Cook DJ. The arc of the pulmonary artery catheter. JAMA 2003 Nov 26; 290:2732-4.

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• Medline abstract (Free)