Transpulmonary thermodilution for advanced cardiorespiratory monitoring

Abstract

Since the introduction of the pulmonary artery catheter (PAC) into clinical practice in the 1970s, this device has been considered to be the gold standard for cardiac out-put measurement and advanced hemodynamic monitoring. Nevertheless, in the last 10 years, its risk-to-benefit ratio has become a subject of controversy. One recent meta-analysis on the impact of the PAC in critically ill patients [1] has presented conclusive results showing that the PAC does not bring any clinical benefit, although its use does not prolong hospital length of stay or increase the mortality rate, as was previously claimed by Connors et al. [2]. Another recent prospective multicenter study on 1041 critical patients came to the same conclusions as the meta-analysis [3]. Finally, in a randomized trial comparing hemodynamic management guided by a PAC with hemodynamic management guided by a central venous catheter (CVC), using an explicit management protocol in 1000 patients with established acute lung injury (ALI), PAC-guided therapy did not improve survival or organ function, but was associated with more complications than the CVC-guided therapy. The authors concluded that these results, when considered with those of previous studies, suggested that the PAC should not be routinely used for the management of patients with ALI [4]. The negative results of the PAC studies have led to a gradual decrease in the use of this monitoring modality. In fact, a survey in Germany in 2006 showed that, in a population of 3877 critically ill patients, less than 15% of patients with the criteria of severe sepsis or septic shock were monitored with a PAC [5]. © 2007 Springer Science + Business Media Inc.