#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

The use of the pulmonary artery catheter in departments of cardiac surgery in the Czech and Slovak Republics – international questionnaire study


Authors: J. Kunstýř;  M. Pořízka
Authors‘ workplace: Klinika anesteziologie, resuscitace a intenzivní medicíny, 1. lékařská fakulta Univerzity Karlovy a Všeobecná fakultní nemocnice v Praze
Published in: Anest. intenziv. Med., 29, 2018, č. 5, s. 251-257
Category:

Overview

Objective:

The aim of the study was to evaluate the frequency with which the pulmonary artery catheter is used in departments of cardiac surgery in the Czech and Slovak Republics, and to study the indications, complications and the use of alternative methods of haemodynamic monitoring.

Design:

Retrospective, international survey.

Setting:

Centres of adult cardiac surgery.

Materials and methods:

An electronic questionnaire focused on data concerning the use of the pulmonary artery catheter between 2015 and 2017 was sent to all twelve adult centres of cardiac surgery in the Czech Republic and to three centres in the Slovak Republic. The data returned from all the Czech centres and from one Slovak centre only.

Results:

The results show the catheter was used in 9.7% (0.7 – 29%) of cases, but with a significant variability among the centres. The most frequently used alternative method of haemodynamic monitoring was echocardiography. Analysis of complications revealed that the most serious complication – heart or pulmonary artery perforation – was recorded in 0.18% of cases.

Conclusion:

The authors found the use of the pulmonary artery catheter to be in accordance with the recommendations and trends in other countries. Because of the absence of evidence of the right heart catheterisation benefits in cardiac surgery, and occurrence of severe complications associated with this method, the authors conclude that the pulmonary artery catheter should be used in the most complicated cases only.

Keywords:

pulmonary artery catheter – cardiac surgery – complications – echocardiography


Sources

1.   Swan HJ, Ganz W, Forrester J, et al. Catheterization of theheart in man with use of a flow-directed balloon-tipped catheter. N Engl J Med. 1970;283:447–451.

2.   Ganz W, Donoso R, Marcus HS, et al. A new technique for measurement of cardiac output by thermodilution in man. AmJ Cardiol. 1971;27:392–396.

3.   Wiener RS, Welch HG. Trends in the use of the pulmonary artery catheter in the United States, 1993–2004. Jama. 2007;298:423–429.

4.   Connors AF, Jr., Speroff T, Dawson NV, et al. The effectiveness of right heart catheterization in the initial care of critically ill patients. SUPPORT Investigators. Jama. 1996;276:889–897.

5.   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: a randomized controlled trial. Jama. 2003;290:2713–2720.

6.   Rajaram SS, Desai NK, Kalra A, et al. Pulmonary artery catheters for adult patients in intensive care. Cochrane Database Syst Rev. 2013:Cd003408.

7.   Pinsky MR, Vincent JL. Let us use the pulmonary artery catheter correctly and only when we need it. Crit Care Med. 2005;33:1119–1122.

8.   Ranucci M. Which cardiac surgical patients can benefit from placement of a pulmonary artery catheter? Crit Care. 2006;10:S6.

9.   Handa F, Kyo SE, Miyao H. Reduction in the use of pulmonary artery catheter for cardiovascular surgery. Masui. 2003;52:420–423.

10. Brovman EY, Gabriel RA, Dutton RP, Urman RD. Pulmonary Artery Catheter Use During Cardiac Surgery in the United States, 2010 to 2014. J Cardiothorac Vasc Anesth. 2016;30:579–584.

11. Judge O, Ji F, Fleming N, Liu H. Current use of the pulmonary artery catheter in cardiac surgery: a survey study.J Cardiothorac Vasc Anesth. 2015;29:69–75.

12. Alms A, Braun J, Dongas A, et al. Guidelines for intensive care in cardiac surgery patients: haemodynamic monitoring and cardio-circulatory treatment guidelines of the German Society for Thoracic and Cardiovascular Surgery and the German Society of Anaesthesiology and Intensive Care Medicine. Thorac Cardiovasc Surg. 2007;2:130–148.

13. Mueller HS, Chatterjee K, Davis KB, et al. ACC expert consensus document. Present use of bedside right heart catheterization in patients with cardiac disease. American College of Cardiology. J Am Coll Cardiol. 1998;32:840–864.

14. Practice guidelines for pulmonary artery catheterization: an updated report by the American Society of Anesthesiologists Task Force on Pulmonary Artery Catheterization. Anesthesiology. 2003;99:988–1014.

15. Harvey S, Harrison DA, Singer M, et al. Assessment of the clinical effectiveness of pulmonary artery catheters in mana­gement of patients in intensive care (PAC-Man): a randomised controlled trial. Lancet. 2005;366:472–477.

16. Marik PE. Obituary: pulmonary artery catheter 1970 to 2013. Ann Intensive Care. 2013;3:38.

17. Hadian M, Pinsky MR. Evidence-based review of the use of the pulmonary artery catheter: impact data and complications. Crit Care. 2006;10:S8.

18. Biancofiore G, Critchley LA, Lee A, et al. Evaluation of an uncalibrated arterial pulse contour cardiac output monitoring system in cirrhotic patients undergoing liver surgery. Br J Anaesth. 2009;102:47–54.

19. Binanay C, Califf RM, Hasselblad V, et al. Evaluation study of congestive heart failure and pulmonary artery catheterization effectiveness: the ESCAPE trial. Jama. 2005;294:1625–1633.

20. Elliott CG, Zimmerman GA, Clemmer TP. Complications of pulmonary artery catheterization in the care of critically ill pa­tients. A prospective study. Chest. 1979;76:647–652.

21. Kearney TJ, Shabot MM. Pulmonary artery rupture associated with the Swan-Ganz catheter. Chest. 1995;108:1349–1352.

22. Rosenwasser RH, Jallo JI, Getch CC, Liebman KE. Complications of Swan-Ganz catheterization for hemodynamic monitoring in patients with subarachnoid hemorrhage. Neurosurgery. 1995;37:872–875; discussion 875–876.

23. Connors AF, Jr., Castele RJ, Farhat NZ, Tomashefski JF, Jr. Complications of right heart catheterization. A prospective autopsy study. Chest. 1985;88:567–572.

24. Murdoch SD, Cohen AT, Bellamy MC. Pulmonary artery catheterization and mortality in critically ill patients. Br J Anaesth. 2000;85:611–615.

25. Shah MR, Hasselblad V, Stevenson LW, et al. Impact of the pulmonary artery catheter in critically ill patients: meta-analysis of randomized clinical trials. Jama. 2005;294:1664–1670.

26. Pearson KS, Gomez MN, Moyers JR, et al. A cost/benefit analysis of randomized invasive monitoring for patients under­going cardiac surgery. Anesth Analg. 1989;69:336–341.

27. Schwann NM, Hillel Z, Hoeft A, et al. Lack of effectiveness of the pulmonary artery catheter in cardiac surgery. Anesth Analg. 2011;113:994–1002.

28. Schwann TA, Zacharias A, Riordan CJ, et al. Safe, highly selective use of pulmonary artery catheters in coronary artery bypass grafting: an objective patient selection method. Ann Thorac Surg. 2002;73:1394–1401; discussion 1401–1392.

29. Arens J. On behalf of the American Society of Anesthe­siologists Committee on Practice Parameters; Anesthesiology. 2003;99:775–776.

30. Chiang Y, Hosseinian L, Rhee A, et al. Questionable benefit of the pulmonary artery catheter after cardiac surgery in high-risk patients. J Cardiothorac Vasc Anesth. 2015;29:76–81.

Labels
Anaesthesiology, Resuscitation and Inten Intensive Care Medicine
Login
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account

#ADS_BOTTOM_SCRIPTS#