The pulmonary artery catheter in anesthesia practice in 2007: An historical overview with emphasis on the past 6 years

The pulmonary artery catheter has been widely used in anesthesiology and critical care medicine. Until recently, only retrospective or relatively weak prospective studies examining its effect on outcome had been performed. Over the past 6 years, however, a number of well-designed prospective trials and statistically sound retrospective studies have been completed. All of these show no benefit and some even reveal a potential for increased morbidity. Reasons for this device's inability to improve outcome are numerous, including wrong patient selection and misinterpretation, but the most impressive and convincing evidence is that filling pressures measured from the catheter, particularly the pulmonary artery "wedge" pressure, have no physiologic value. The wedge pressure has been shown to not correlate with other accepted methods of determining left ventricular filling or volume or intravascular volume and also does not help to generate cardiac function curves. Therefore, knowledge of it may actually lead to incorrect management more frequently than not.