Right heart catheterization in acute lung injury - An observational study

Right heart catheterization (RHC) is commonly used in the diagnosis and man agement of acute lung injury (ALI). However, controversy exists regarding R HC. We examined RHC use during the first 3 d of ALI in an observational stu dy of 135 patients defined by American-European Consensus Conference criter ia. Study parameters examined for association with RHC included the Acute P hysiology and Chronic Health Evaluation (APACHE) III score, lung injury sco re (LIS), and 20 additional epidemiologic, clinical, and laboratory paramet ers. RHC was performed in 70 patients (52%) within the first 3 d of ALI. RH C was positively associated (p < 0.05) with a diagnosis of sepsis, APACHE I II score, blood urea nitrogen (BUN), creatinine, net fluid balance, and pos itive end-expiratory pressure. RHC was negatively associated (p < 0.05) wit h mean arterial pressure (<(Pa)over bar>) and Pa-o2/FIo2. Logistic regressi on identified four predictors for RHC placement: sepsis, Pa-o2/FIo2, BUN, a nd <(Pa)over bar>. Initial right atrial and pulmonary artery occlusion pres sure measurements demonstrated a moderately strong correlation (r = 0.72). Use of RHC was associated with a change in one or more therapeutic interven tions (intravascular fluids, vasopressors, diuretics) in 78% of patients. I n summary, patients receiving RHC during the first 3 d of ALI were more sev erely ill than those who did not receive RHC, and RHC was associated with a change in therapy in most patients.