Routine perioperative pulmonary artery catheterization has no effect on rate of complications in vascular surgery: A meta-analysis

Despite widespread use pulmonary artery catheterization has not been proven to reduce complications or mortality. One study supported the use of routi ne preoperative pulmonary artery catheterization in moderate-risk vascular surgery patients; several other studies have reported that pulmonary artery catheterization is not efficacious. Our goal was to scrutinize the data us ing meta-analysis. This is a systematic review of the literature. MEDLINE w as searched for all articles on pulmonary artery catheterization, optimizat ion, oxygen delivery, and preoperative preparation of vascular surgery pati ents. Data from papers judged appropriate for inclusion were analyzed using a computer program, Easy MA. Complications were defined as only those that could have reasonably have been prevented by or resulted from pulmonary ar tery catheterization. Of hundreds of possible papers only four were found t o be adequate randomized prospective studies with similar exclusions, thera peutic endpoints, and interpretable complication and mortality rates. Contr ols included 174 patients versus 211 in the protocol group. Power analysis showed that the combined sample sizes were adequate. The meta-analysis demo nstrates that the studies are homogeneous. The use of a pulmonary artery ca theter does not prevent morbidity or mortality. Of the studies providing da ta on the amount of intravenous fluid administered three reported that stat istically significantly more fluid was given to patients who underwent pulm onary artery catheterization. Meta-analysis indicates that in moderate-risk vascular surgery patients routine preoperative pulmonary artery catheteriz ation is not associated with improved outcomes.