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Once Again, No Benefit from Pulmonary Artery Catheters

Pulmonary artery catheterization did not improve outcomes in mechanically ventilated patients with acute lung injury.

In recent randomized trials, pulmonary artery catheters (PACs; also known as Swan-Ganz catheters) were not beneficial in high-risk surgical patients, patients with shock and acute respiratory distress syndrome, or patients with heart failure. Now, in a multicenter randomized North American trial (the Fluids and Catheters Treatment Trial, or FACTT), investigators focused on yet another population — patients with acute lung injury who require mechanical ventilation. One thousand such patients received either PACs or central venous catheters (CVCs), and hemodynamic interventions were guided by explicit protocols according to PAC or CVC measurements. The most common causes of lung injury were pneumonia (47%), severe sepsis (23%), and aspiration (15%); 35% of patients met criteria for shock.

There was no difference between the PAC and CVC groups in the primary outcome, the mortality rate during the first 60 days after randomization (27% and 26%). In addition, no significant differences between groups were noted for a variety of secondary outcomes, including number of ventilator-free days, number of days without other types of organ failure, and clinical course for patients with shock.

Comment: In this study, pulmonary artery catheterization did not improve outcomes in mechanically ventilated patients with acute lung injury. The standardized management protocols, which ensured that hemodynamic measurements were used properly to guide treatment, were a strength of this trial. Although it remains possible that certain subgroups of critically ill patients benefit from pulmonary artery catheters, that possibility wanes as the number of randomized trials with negative results increases.

— Allan S. Brett, MD

Published in Journal Watch General Medicine June 2, 2006

Citation(s):

The National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network. Pulmonary-artery versus central venous catheter to guide treatment of acute lung injury. N Engl J Med 2006 May 25; 354:2213-24.

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