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• W4243165148 abstract "As originally conceived, one objective of this column is to provide a platform for contrary opinions. Another (unstated) objective is to provide a written historic record of current medical thinking about certain issues in chest medicine. A recent editorial of mine on the dangers of the pulmonary artery catheter has evoked a number of contrary responses defending the use of the catheter My column this month reproduces these criticisms. As the medical literature has scarcely been starved for favorable comments concerning the use of the instrument, I have taken the liberty of discussing each critical letter My comments appear in italics. Defenders of the Pulmonary Artery CatheterCHESTVol. 93Issue 5PreviewDr. Bartlett's letter is written as satire and I appreciate the delicacy of style. His argument is largely based on a single assumption—that the patients in whom the catheter was used were more ill than the control subpopulations—which entirely explains the difference in outcome. He is, of course, entitled to any assumption that he wishes to espouse. But, in fact, the data of Gore et al do not support the validity of Dr. Bartlett's assumption. When patients with pulmonary edema with and without the catheter were studied, those with the catheter had a significantly higher case fatality rate (CFR) (p<0.001). Full-Text PDF Defenders of the Pulmonary Artery CatheterCHESTVol. 93Issue 5PreviewWhen subgroups of patients with pulmonary edema and hypotension, with and without catheters, were examined there was still a 100 percent increase in mortality in the catheterized group (see reply to Dr. Bartlett). Full-Text PDF Defenders of the Pulmonary Artery CatheterCHESTVol. 93Issue 5PreviewTo the Editor: Full-Text PDF Defenders of the Pulmonary Artery CatheterCHESTVol. 93Issue 5PreviewTo the Editor: Full-Text PDF Defenders of the Pulmonary Artery CatheterCHESTVol. 93Issue 5PreviewDr. Civetta provides a more sophisticated rationalization than others for performing invasive tests despite lack of demonstrable improvement of patient outcome. In this rationalization, the benefits may be masked by the totality of the clinical analysis and hence may not be capable of being demonstrated. Full-Text PDF Defenders of the Pulmonary Artery CatheterCHESTVol. 93Issue 5PreviewTo the Editor: Full-Text PDF Defenders of the Pulmonary Artery CatheterCHESTVol. 93Issue 5PreviewTo the Editor: Full-Text PDF Defenders of the Pulmonary Artery CatheterCHESTVol. 93Issue 5PreviewTo the Editor: Full-Text PDF Defenders of the Pulmonary Artery CatheterCHESTVol. 93Issue 5PreviewThere are four assumptions in this letter that warrant comment. 1) These physicians know how to recognize those few patients who “should” be catheterized. There is, of course, no valid data base to evaluate this claim. 2) High mortality associated with use of the catheter is related to the inexperience of some catheterizers. Of course, differential skill of physicians is a fact of life influencing the outcome of all technologic approaches in medicine. One leader of the Swan-Ganz movement has attributed the high complication rate to its use by nonsurgeons as contrasted to surgical users. Full-Text PDF Defenders of the Pulmonary Artery CatheterCHESTVol. 93Issue 5PreviewDr. Spodick is a clinical epidemiologist, a distinguished editor of a journal (American Journal of Noninvasive Cardiology) and is one of the authors of the Gore article. It is not for these reasons alone that I hope readers will pay close attention to his communication. An analysis of his communication provides some scientific and, more critically, some clinical insights into some important issues. I will take the liberty of addressing him personally. Full-Text PDF Defenders of the Pulmonary Artery CatheterCHESTVol. 93Issue 5PreviewTo the Editor: Full-Text PDF Pulmonary Artery CathetersCHESTVol. 93Issue 5PreviewCommunications for this section will be published as space and priorities permit. The comments should not exceed 350 words in length, with a maximum of five references; one figure or table can be printed. Exceptions may occur under particular circumstances. Contributions may include comments on articles published in this periodical, or they may be reports of unique educational character. Specific permission to publish should be cited in a covering letter or appended as a postscript. Full-Text PDF Defenders of the Pulmonary Artery CatheterCHESTVol. 93Issue 5PreviewDr. Topaz is disturbed by lack of pathologic support for death and disability from the catheter This raises two issues One is that, of course, there are such data: the paper by Rowley et al1 is the best single source. That group at least compared intracardiac lesions in catheterized vs noncatheterized patients. The study by Lange et al2 was prospective—that is, it was not based on chart review—but it was not controlled or randomized. Even so, 61 percent of the patients showed mural thrombi; valvular hemorrhage was found in 31 percent of the cases and valvular vegetation in 8 percent. Full-Text PDF Defenders of the Pulmonary Artery CatheterCHESTVol. 93Issue 5PreviewTo the Editor: Full-Text PDF" @default.
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• W4243165148 title "Defenders of the Pulmonary Artery Catheter" @default.
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