The researchers, who reported the results of their analysis in the Oct. 5, 2005, issue of the Journal of the American Medical Association (JAMA), concluded that PACs should not be used routinely in patients in intensive care units (ICU), patients with severe heart failure or patients undergoing surgery, until further studies can uncover any correlations between outcomes from the use of the device with specific treatments.
In using the device, physicians insert a catheter into the venous system around the heart to obtain information about a variety of hemodynamic parameters, such as filling pressures, pumping strength of the heart, saturation levels of oxygen in the blood and how much fluid is being retained. The procedure is usually performed at the bedside, and the catheter can be left in place for a number of days to provide constant monitoring. More than 1 million PAC procedures are performed each year in the U.S.
"The main question this study raises is where the use of PAC fits into the overall therapeutic plan for these patients," said cardiologist Monica Shah, M.D., first author of the paper. She led the team while at the DCRI before leaving Duke for Columbia University Medical Center. "The PAC is a diagnostic tool, like an x-ray or an electrocardiogram, and as such, we don't necessarily expect them to improve outcomes on their own.
"Our analysis showed that PAC doesn't improve outcome as a part of a therapeutic strategy," she continued. "Maybe the catheter could be helpful if, for example, it guide
Contact: Richard Merritt
Duke University Medical Center