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Critical Care Medicine


Answer 3
  1. PAC use does not benefit patients with ARDS. A recent multicenter randomized trial examined the use of PAC in patients with septic shock, ARDS, or both and found that PAC use did not affect mortality or morbidity in either condition.3 Another large, multicenter, randomized trial examined perioperative PAC use in high-risk surgical patients undergoing major surgery and found no evidence of benefit from PAC-guided treatment compared with standard care.5 Potential explanations for this lack of benefit include inaccurate and variable interpretation of PAC data, variable endpoints and treatments for hemodynamic instability, and reliance on CVP and PAWP to guide or dictate treatment. Furthermore, the PAC is a monitoring technology as opposed to a therapeutic technology; for a monitoring technology to change outcome, the disease state it is used to monitor must have an effective treatment. Critically ill patients with multi-organ failure, ARDS, or shock do not yet have treatments as effective as those for cardiac conditions in which another monitoring technology, the electrocardiogram, clearly improves outcomes (eg, early detection of ischemia treated with angioplasty).3,5

    REFERENCES
    3. Richard C, Warszawski J, Anguel N, et al. Early use of the pulmonary artery catheter and outcomes in patients with shock and acute respiratory distress syndrome. JAMA 2003;290:2713-20.

    5. Sandham JD, Hull RD, Brant RF, et al. A randomized, controlled trial of the use of pulmonary-artery catheters in high-risk surgical patients. N Engl J Med2003;348:5-14.

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