Pulmonary artery catheterization
From Standard of Care
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Provides hemodynamic information, including cardiac index and pulmonary artery occlusion pressure data.
Utilizes a flow directed balloon tipped catheter to measure intracardiac filling pressures.
Provides basis for understanding of the pathophysiological mechanisms for heart failure.
Hemodynamic data obtained with the use of PA catheterization provides diagnostic information and is the procedure of choice for the diagnosis of pulmonary arterial hypertension, shock of unknown etiology, and quantification of the intracardiac shunts.
A number of randomized studies cast doubt on the benefits of such management In the critical care setting.
Use in high risk surgical patients, patients with acute respiratory distress, sepsis, congestive heart failure or critical medical illnesses not reported to provide benefits.
Guided therapy does not improve survival or organ function, but is associated with more complications than the use of central venous catheter guided management in patients with acute lung injury.
Use in ARDS and shock not associated with an increase morbidity and mortality.
Data derived from pulmonary artery catheterization hemodynamics in the absence of effective therapy may lack application and even be harmful.
An example of harm from such data occurs when a low cardiac output is identified and administration of an inotropic agent such dobutamine is given to improve cardiac output: in this setting such management is associated with increased mortality (Eikayam U et al).
ESCAPE (Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness) trial, a randomized trial of PA catheter guided management vs standard clinical decisions: no effect on days alive and out of the hospital at 6 months, and patients with the catheter had higher rates of infections and arrhythmias (Binanay C et al)>
Provides pressure measurement for the right atrium, right ventricle, pulmonary arteries, pulmonary capillary wedge pressure, and a way to measure cardiac output by thermo dilution.
Routine use is to be avoided but can be helpful in patients with congenital heart disease, pulmonary arterial hypertension and in patients in need of complex fluid management.
The main sites of insertion include the right internal jugular vein or the left subclavian vein, but the femoral or brachial vein can be utilized as well.
Fluoroscopic guidance improves the ability to pass the pulmonary artery catheter and should be used when right ventricle dysfunction, pulmonary artery hypertension, tricuspid regurgitation, or right atrial enlargement is present.