Pulmonary artery catheters and outcome in the perioperative period

Objective: To review the literature addressing use of the pulmonary artery catheter (PAC) in the perioperative patient. Data Source: All pertinent English language articles dealing with the use of pulmonary artery catheterization in perioperative patients were retrieved from 1977 through 1996. Study Selection: Articles were chosen if the perioperative use of pulmonary artery catheterization was studied or reviewed. Data Extraction: From the articles selected, information was obtained about changes in therapy and changes in outcome associated with PAC use in patients undergoing cardiac surgery, aortic surgery, peripheral vascular surgery, and neurosurgery. Information was also extracted about perioperative PAC use in geriatric patients and in patients with preeclampsia. Data Synthesis: Low-risk patients undergoing cardiac surgery do not appear to benefit from PAC use. Studies looking at high-risk patients undergoing cardiac surgery are lacking, making accurate determination of patient benefit difficult. The PAC may be useful in the management of some patients undergoing aortic surgery, though recent studies have identified populations of patients that can be safely monitored by less invasive means. Use of the PAC may lead to fewer complications in high risk patients undergoing peripheral vascular surgery. Until data are forthcoming, it is not possible to accurately assess the overall impact of PAC use on complications and mortality in patients undergoing neurosurgical procedures. However, use of the PAC to monitor and treat air embolism in this group of patients does not appear to be appropriate. Routine perioperative use of the PAC does not appear to be appropriate because of age alone. Available scientific data do not support use of the PAC in patients with uncomplicated preeclampsia; however, some experts feel that PAC use may be helpful in the management of selected patients with severe preeclampsia. Conclusion: There are no Grade A indications for PAC use in the perioperative period. Current available literature suffers from a lack of randomized controlled clinical trials. Multicentered randomized controlled trials are needed.