POTENTIAL IMPACT OF PULMONARY-ARTERY CATHETER PLACEMENT ON SHORT-TERMMANAGEMENT DECISIONS IN THE MEDICAL INTENSIVE-CARE UNIT

The purpose of this study was to examine the potential impact of pulmo nary artery (PA) catheter placement on short-term management decisions in the medical intensive care unit (ICU). One hundred three patients were examined over an 18-month period. The predominant indications for PA-catheter placement included refractory congestive heart failure, a irspace disease, uncertain cardiac filling pressures, or hypotension. In 58 (56%) of the 103 patients, management recommendations changed as a direct result of knowledge gained by PA catheter placement. These c hanges involved fluid therapy recommendations in 41 patients, vasopres sor use in 17 patients, intravenous vasodilator use in 24 patients, an d recommendations for the use of inotropic agents in 15 patients. Alth ough 18 patients experienced early or late complications, major events were limited to a single pneumothorax requiring chest tube insertion and four episodes of bacteremia. No deaths were directly attributable to the catheter insertion. In critically ill patients in the medical i ntensive care unit, PA-catheter placement leads to changes in recommen dations for management in a substantial portion of patients with littl e risk of life-threatening complications in those who receive such inv asive monitoring.