DIAGNOSTIC VALIDITY OF PULMONARY-ARTERY CATHETERIZATION FOR RESIDENTSAT AN INTENSIVE-CARE UNIT

Objective: To assess the amount of additional information provided by measurements derived from pulmonary artery catheter (PAC) use beyond t hat derived from clinical evaluation by intensive care residents. Meth ods: One hundred forty-nine consecutive patients undergoing right-hear t catheterization were prospectively included in the study, Before ins erting a PAC, physicians had to predict pulmonary arterial pressure (P AP), pulmonary capillary wedge pressure (PCWP), systemic vascular resi stance index (SVRI), cardiac index (CI), mixed venous oxygen saturatio n (SVO2), oxygen delivery (DO2), oxygen consumption (VO2), and pulmona ry shunt fraction (Qs/Qt) by selecting a given option on a questionnai re. Ranges of options mere chosen to create clear clinical differences among them. Results: The correct value was predicted in a median of 5 0% of cases (range, 45-63%). PAP was predicted correctly in 55%, PCWP in 46%, SVRI in 63%, CI in 62%, SVO2 in 45%, DO2 in 45%, VO2 in 51%, a nd Qs/Qt in 51%. A significant difference was found between estimated and measured values for all parameters (p < 0.01). No significant diff erences were detected between more and less experienced physicians. Th ere was no significant difference between estimated and measured value s with respect to the different courses of intensive care unit admissi ons or the different indications for PAC insertion, Conclusion: In a s elected group of critically ill patients, the PAC adds valuable and cl inically relevant information to clinical assessment in about 50% of c ases, Its use should not be withheld ira patients with unclear hemodyn amic and metabolic profiles.