Document Detail

Pulmonary artery catheterization. Can there be an integrated strategy for guideline development and research promotion?
MedLine Citation:
PMID:  8479068     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: To review the evidence regarding indications for pulmonary artery catheterization (PAC) in critically ill patients, and to propose a guideline-generating process that would encourage randomized controlled trials of PAC.
DATA SOURCES: Computerized and manual search for randomized trials involving PAC as an integral part of the protocol, published as of October 1992. Manual search for guidelines endorsed by specialty societies and/or proposed by expert panels following an explicit group process.
DATA SYNTHESIS: Four trials suggest benefit from PAC for pre- or perioperative management of high-risk surgical patients. Two others indicate that PAC for low-risk aortic aneurysm surgery confers no advantages. Use of PAC to guide therapy aimed at improved mixed venous oxygen saturation was beneficial compared with usual care with PAC in two small trials among patients with septic shock and severe trauma. Other PAC indications are either untested or inadequately tested by small trials. Large trials are needed, but trials to date have been impeded by clinicians' uncertainty about PAC and unwillingness to randomize critically ill patients. No published guidelines for PAC have used a formal group process and/or a hierarchical review of evidence to demarcate proven from unproven indications.
CONCLUSIONS: We propose a research-promoting expert panel on indications for PAC. Aided by a critical literature review, experts would rate case scenarios on the need for routine PAC with or without a specified intervention strategy. Future trials should test indications where there is either consensus about the uncertainty of need for PAC, or interpanelist disagreement owing to inconclusive evidence. This process could facilitate practice guideline development, utilization management, and large trials of PAC and related interventions.
C D Naylor; W J Sibbald; C L Sprung; S P Pinfold; J E Calvin; F B Cerra
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Review    
Journal Detail:
Title:  JAMA     Volume:  269     ISSN:  0098-7484     ISO Abbreviation:  JAMA     Publication Date:  1993 May 
Date Detail:
Created Date:  1993-05-25     Completed Date:  1993-05-25     Revised Date:  2014-09-17    
Medline Journal Info:
Nlm Unique ID:  7501160     Medline TA:  JAMA     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  2407-11     Citation Subset:  AIM; IM    
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MeSH Terms
Cardiac Catheterization / statistics & numerical data,  utilization
Catheterization, Swan-Ganz / standards,  utilization*
Practice Guidelines as Topic*
Randomized Controlled Trials as Topic
Technology Assessment, Biomedical / methods*
United States
Comment In:
JAMA. 1993 Oct 27;270(16):1933-4   [PMID:  8280255 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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