Abstract
The use of pulmonary artery catheters is under debate yet again. We look at two recent trials evaluating their impact on mortality. Our suspicions regarding obesity are proven and we also look at a simple, cost effective method of reducing ventilator-associated pneumonia. Finally, an intervention to improve the poor outcome associated with out-of hospital cardiac arrests is evaluated.
Highlights
The invention of the pulmonary artery catheter (PAC) 38 years ago by Drs Jeremy Swan and William Ganz was embraced by the medical world wholly and enthusiastically
Is the ‘Swan’ destined for extinction? Proponents of PAC will point out that the conclusion only applies to a relatively young, medical intensive therapy unit (ITU) population and excluded the majority of the 11,511 patients screened. These proponents will favour the study by Friese and colleagues [3], who scrutinised the American National Trauma Data Bank in a retrospective database analysis to assess the role of PACs on mortality in adult trauma patients admitted to ITU over an eight year period
Mortality rates were similar in both groups (27.4% PAC and 26.3% central venous catheter (CVC)), as were the number of ventilator-free days during the first 28 days
Summary
The invention of the pulmonary artery catheter (PAC) 38 years ago by Drs Jeremy Swan and William Ganz was embraced by the medical world wholly and enthusiastically. PAC patients, in whom a CVC may have been placed once haemodynamically stable, received 50% more catheters, increasing the total number of complications, mostly arrhythmias, in this group. These proponents will favour the study by Friese and colleagues [3], who scrutinised the American National Trauma Data Bank in a retrospective database analysis to assess the role of PACs on mortality in adult trauma patients admitted to ITU over an eight year period.
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