Document Detail

The appropriateness of the pulmonary artery catheter in cardiovascular surgery.
MedLine Citation:
PMID:  11861346     Owner:  NLM     Status:  MEDLINE    
PURPOSE: The pulmonary artery catheter (PAC) is commonly used in anesthesiology and critical care, but its appropriate (where benefit exceeds risk) application is unknown. This study describes current clinical practice attitudes among anesthesiologists in cardiac and vascular surgery in an effort to determine the most appropriate indications for use of the PAC. METHODS: Anonymous, cross-sectional, mailed survey of anesthesiologists in Canada and the USA. Opinions of anesthesiologists about the appropriateness of PAC application were assessed in 36 clinical scenarios, using a nine-point Likert scale. The RAND method was adapted to identify appropriate, inappropriate, and uncertain indications for PAC application. RESULTS: Seventy-seven percent of 345 anesthesiologists responded. They agreed strongly (87%) that use of the PAC is appropriate in patients with severe ventricular impairment and unstable angina. Agreement was also present with ventricular impairment (74%) or unstable angina (55%) alone, but was less strong. A majority (53%) rated the PAC as not appropriate in the routine patient without complicating risk factors. Those who used the PAC more frequently, who had a greater practice volume, and who practised in Canada rated PAC use to be more appropriate in more scenarios. Those who did more continuing medical education rated PAC use to be less appropriate. CONCLUSIONS: While the ideal evaluation of the PAC in clinical practice would be a randomized controlled trial, such an undertaking is time-consuming, expensive, of limited generalizability, and requires clinical equipoise. This study found strong agreement that PAC application is appropriate in some patient scenarios, and agreement that it is inappropriate in others. Description of current practice using this method may identify scenarios where randomized evaluation of the PAC, or other technologies, is likely unnecessary, and others where it is highly likely to be highly beneficial.
Michael J Jacka; Marsha M Cohen; Teresa To; J Hugh Devitt; Robert Byrick
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Canadian journal of anaesthesia = Journal canadien d'anesthésie     Volume:  49     ISSN:  0832-610X     ISO Abbreviation:  Can J Anaesth     Publication Date:  2002 Mar 
Date Detail:
Created Date:  2002-02-25     Completed Date:  2002-06-12     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  8701709     Medline TA:  Can J Anaesth     Country:  Canada    
Other Details:
Languages:  eng     Pagination:  276-82     Citation Subset:  IM    
Department of Anaesthesia and Critical Care, University of Toronto, Canada.
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MeSH Terms
Cardiac Surgical Procedures*
Catheterization, Swan-Ganz*
Multivariate Analysis
Vascular Surgical Procedures*
Comment In:
Can J Anaesth. 2002 Mar;49(3):226-31   [PMID:  11861338 ]
Can J Anaesth. 2002 Nov;49(9):1001-2; Author Reply 1002-3   [PMID:  12419738 ]

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

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