Principles of Critical Care > Part II. General Management of the Patient > Chapter 13. Clinical Use of the Pulmonary Artery Catheter James W. Leatherman,  John J. Marini

Key Points

"Although the pulmonary artery catheter (PAC) has been in use for more than 30 years,¹ its value in management of critically ill patients remains controversial. Different studies have concluded that use of the PAC is associated with increased mortality,^2,3 has no effect on mortality,^4,5 or decreases major morbidity.^6,7 Several prospective, randomized studies have been initiated within the last few years in an effort to better define the impact of the PAC on patient outcome.⁸ Three trials have been completed, and none found an impact of the PAC on mortality.^9–11 The appropriateness of these trials has been questioned,^8,12,13 and it has been suggested that efforts instead should be directed toward improvement of the standard of practice through intensive educational efforts, institution of more stringent accreditation policies, and evaluation of newer monitoring techniques before proceeding with expensive and time-consuming randomized clinical trials.^8,12,13 The latter view is based in part on evidence that ICU nurses and physicians who use the PAC may have significant deficiencies in knowledge about some of the most fundamental aspects of hemodynamic monitoring,^14,15 raising concern that the value of the PAC may be difficult to assess if data are not collected and interpreted optimally.¹⁶..."