Turner White CommunicationsAbout TWCSubscribeContact TWCHomeSearch
Hospital PhysicianJCOMSMPBRMsCart
Current Contents
Past Issue Archives
Self-Assessment Questions
Review of
Clinical Signs
Clinical Review
Pediatric Rounds
Resident Grand Rounds
Article Archives
Case Reports
Clinical Practice
Pediatric Rounds
Resident Grand Rounds
Review of
Clinical Signs

Guide to Reading
Hospital Physician
Editorial Board
Information for Authors

Reprints, Permissions, & Copyright
Site Map
Self-Assessment Questions

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

    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.

Click here to return to the questions


Hospital Physician     JCOM     Seminars in Medical Practice
Hospital Physician Board Review Manuals
About TWC    Subscribe    Contact TWC    Home    Search   Site Map

Copyright © 2009, Turner White Communications
Updated 1/04/08 • kkj