The role of pulmonary artery catheterisation in the perioperative period in high risk patients

Purpose: Pulmonary artery catheterisation for hemodynamic monitoring has been traditionally used to guide the management of critically ill patients. This practice has been questioned, in light of a recent prospective cohort study, which demonstrated a higher mortality for patients monitored with a pulmonary artery catheter (PAC) (JAMA 1996;276:889). However results from this and other studies may not apply to the specific circumstances of the perioperative patient. Therefore, we investigated the value of PAC monitoring during the perioperative period in high risk orthopedic patients. Methods: We retrospectively studied 69 patients (36 male and 33 females) who received perioperative PAC monitoring, guided by critical care specialists, during a 24 month period. Patients ages ranged from 23 to 98, with a median age of 73 years. Patients received hip (29), knee (18), spine (14) or other (8) types of orthopedic surgery. Indications for PAC insertion included severe coronary artery disease (CAD)(19); cardiomyopathy: ischemic (16), non-ischemic (10); severe valvular heart disease (8),with associated CAD (5); others (11). Results: Complications included balloon dysfunction (2), asymptomatic, brief episodes of supraventricular (1) and ventricular tachycardia (1). Data obtained with the PAC were inconsistent with the clinical impression in 7 cases. PAC data dictated immediate intervention in 12 cases (fluid n=8), (diuretics n=4), and led to delayed (n=1) or canceled surgery (n=1). Conclusions: Perioperative PAC monitoring in high risk orthopedic patients altered management in a substantial number of cases (17%) and was associated with only minimal complications. Clinical Implications: In the hands of critical care specialists PAC monitoring can be a useful tool in the perioperative management of high risk patients.