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• W3126293314 abstract "Central MessageIn patients with preserved ejection fraction and a shorter bypass, continuous monitoring of hemodynamic parameters by pulmonary artery catheter did not improve operative morbidity or mortality.See Article page 1965. In patients with preserved ejection fraction and a shorter bypass, continuous monitoring of hemodynamic parameters by pulmonary artery catheter did not improve operative morbidity or mortality. See Article page 1965. There appears to be a persistent enthusiasm for a continual investigation into whether the use of pulmonary artery catheter (PAC) leads to reduced morbidity and mortality in critically ill patients. Perhaps no other monitoring tool enjoys being consistently trendy for several decades. A wide spectrum of opinions can be found in the literature. Some authors already have written an obituary to PAC,1Marik P.E. Obituary: pulmonary artery catheter 1970 to 2013.Ann Intensive Care. 2013; 3: 38Crossref PubMed Scopus (58) Google Scholar some argue that PAC is immortal,2De Backer D. Vincent J.L. The pulmonary artery catheter: is it still alive?.Curr Opin Crit Care. 2018; 24: 204-208Crossref PubMed Scopus (28) Google Scholar and others believe that “in medio virtus,” finding PAC more alive than dead.3Vincent J.L. Pinsky M.R. Sprung C.L. Levy M. Marini J.J. Payen D. et al.The pulmonary artery catheter: in medio virtus.Crit Care Med. 2008; 36: 3093-3096Crossref PubMed Scopus (98) Google Scholar Another category of publications, similarly to Brown and colleagues, focuses on certain patient populations, relies on thorough statistical analysis, and avoids generalized and emotional statements.4Schwann N.M. Hillel Z. Hoeft A. Barash P. Möhnle P. Miao Y. et al.Lack of effectiveness of the pulmonary artery catheter in cardiac surgery.Anesth Analg. 2011; 113: 994-1002Crossref PubMed Scopus (94) Google Scholar,5Brown J.A. Aranda-Michel E. Kilic A. Serna-Gallegos D. Bianco V. Thoma F.W. et al.The impact of pulmonary artery catheter use in cardiac surgery.J Thorac Cardiovasc Surg. 2022; 164: 1965-1973.e6Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar It has been suggested that the information provided by PAC might be inaccurate, insertion is associated with complications, and the rate of misinterpretation of data is alarming.1Marik P.E. Obituary: pulmonary artery catheter 1970 to 2013.Ann Intensive Care. 2013; 3: 38Crossref PubMed Scopus (58) Google Scholar In addition, many demonstrated no improved mortality in patients with PACs.6Rajaram S.S. Desai N.K. Kalra A. Gajera M. Cavanaugh S.K. Brampton W. et al.Pulmonary artery catheters for adult patients in intensive care.Cochrane Database Syst Rev. 2013; 2013: CD003408PubMed Google Scholar In turn, advocates of PAC emphasize the importance of the ability to measure pulmonary artery pressure, including occlusion pressure and mixed venous saturation, invaluable in the management of patients with marked myocardial dysfunction and pulmonary hypertension.3Vincent J.L. Pinsky M.R. Sprung C.L. Levy M. Marini J.J. Payen D. et al.The pulmonary artery catheter: in medio virtus.Crit Care Med. 2008; 36: 3093-3096Crossref PubMed Scopus (98) Google Scholar Because of “limited and conflicting data,” Brown and colleagues5Brown J.A. Aranda-Michel E. Kilic A. Serna-Gallegos D. Bianco V. Thoma F.W. et al.The impact of pulmonary artery catheter use in cardiac surgery.J Thorac Cardiovasc Surg. 2022; 164: 1965-1973.e6Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar took another look at the PAC in the setting of cardiac surgery. They studied 11,820 patients, and identified 3519 propensity-matched pairs managed with and without PAC. They found that PAC use was not associated with improved operative mortality. It was concluded that “PAC may have limited benefit in cardiac surgery.” The manuscript is very well written and convincing, but it is important not to overlook the supplemental data. Study patients had preserved left ventricular ejection fraction (>40%), reasonably short ischemic time (around 80 minutes), and the majority (around 90%) had primary sternotomy. Therefore, no conclusions can be extrapolated to patients with low ejection fraction, prolonged cardiopulmonary bypass time, and repeat cardiac surgery. This study raises awareness that one should be more conscious when deciding “to throw in a Swan” in a “bread-and-butter” cardiac case. As a compromise, an introducer instead of a regular central line catheter can be inserted for central access and PAC can be floated later if needed. Many cardiac anesthesiologists have to cleverly balance their own thoughts and surgical preferences. The “habitual” placement of PAC should be minimized based on data provided by Brown and colleagues.5Brown J.A. Aranda-Michel E. Kilic A. Serna-Gallegos D. Bianco V. Thoma F.W. et al.The impact of pulmonary artery catheter use in cardiac surgery.J Thorac Cardiovasc Surg. 2022; 164: 1965-1973.e6Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar It is possible to safely get the patient through complex cardiac operation without PAC. In congenital cardiac surgery, PAC often is not an option. In the dire circumstances of low cardiac output (sometimes of a single ventricle) or acute pulmonary hypertension, PAC could help to diagnose and intervene, but instead one must fully rely on signs of perfusion adequacy, not a straightforward task. In conclusion, PAC is an intricate tool. It can be a burden when everything goes well, but it could be very helpful when things get tricky. Fortunately, the PAC ship has not sailed; on the contrary, the anchor seems dug in, and that must be fixed. The impact of pulmonary artery catheter use in cardiac surgeryThe Journal of Thoracic and Cardiovascular SurgeryVol. 164Issue 6PreviewPulmonary artery catheterization provides continuous monitoring of hemodynamic parameters that may aid in the perioperative management of patients undergoing cardiac surgery. However, prior data suggest that pulmonary artery catheterization has limited benefit in intensive care and surgical settings. Thus, this study sought to determine the impact of pulmonary artery catheter insertion on short-term postoperative outcomes in a large, contemporaneous cohort of patients undergoing open cardiac surgery compared with standard central venous pressure monitoring. Full-Text PDF" @default.
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• W3126293314 title "Commentary: Has pulmonary artery catheter ship sailed?" @default.
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