New horizons (Baltimore, Md.)
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To 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. ⋯ Hemodynamic 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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To review the literature addressing the use of the pulmonary artery catheter (PAC) in patients with cardiovascular disease. ⋯ Pulmonary artery catheterization is often used to optimize patient management, although this may not be demonstrable in terms of prospective trials using mortality or other "hard" outcome measures. Nonetheless, more rapid diagnosis and achievement of therapeutic endpoints guided by PAC use can decrease morbidity and intensive care days.
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To review the literature addressing use of the pulmonary artery catheter (PAC) in pediatric patients. ⋯ Until there is substantive evidence in children that outcome is negatively affected by their use, PACs should remain available. Experienced physicians should directly supervise PAC insertion and use.
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To review the literature addressing economic issues related to use of the pulmonary artery catheter (PAC). ⋯ Widespread use of the PAC has significant economic ramifications. Data regarding cost-effectiveness of the PAC is extremely limited in terms of methodology and scope. Economic impact and cost-effectiveness are moot prior to establishing clinical efficacy.
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To review the literature addressing the issue of a U.S. Food and Drug Administration (FDA) moratorium on use of the pulmonary artery catheter (PAC). ⋯ An FDA moratorium on the use of the PAC is not indicated.