• O C Kirton and J M Civetta.
• Surgical Intensive Care Unit at the University of Miami/Jackson Memorial Medical Center, FL 33101, USA.
• New Horiz. 1997 Aug 1; 5 (3): 222-7.

ObjectiveTo review the literature addressing the use of the pulmonary artery catheter (PAC) in victims of blunt and penetrating trauma and examine the available evidence that supports or refutes the claim that PAC use alters outcome in this patient population. Furthermore, to determine what additional research should be done in this area.Data SourceAll pertinent English language articles dealing with pulmonary artery catheterization in trauma patients were retrieved from 1979 through 1996.Study SelectionClinical studies were considered if PACs were used to establish a cardiopulmonary diagnosis, optimize or achieve endpoints of oxygen transport and utilization indices, or guide and/or determine response to therapy. Emphasis was placed on prospective, randomized, controlled trials. However, descriptive case series and retrospectively-analyzed, uncontrolled reviews comprise the majority of available literature.Data ExtractionFrom these selective studies, information was obtained regarding patient demographics, therapeutic endpoints, and achieved outcome.Data SynthesisInsufficient evidence exists to support a true survival benefit. However, recommendations for indications can be proposed where a reduction in morbidity or improvement in functional outcome is suggested.ConclusionHemodynamic data obtained from the PAC appear to be beneficial for the following indications: a) to ascertain the status of underlying cardiovascular performance and/or the need for improvement; b) to direct therapy when noninvasive monitoring may be inadequate, misleading, or the endpoints of resuscitation difficult to define; c) to assess response to resuscitation; d) to potentially decrease secondary injury when severe closed-head or acute spinal cord injuries are components of multisystem trauma; e) to augment clinical decision-making when major trauma is complicated by severe adult respiratory distress syndrome, progressive oliguria/anuria, myocardial ischemia, congestive heart failure, or major thermal injury; and f) to establish futility of care.

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