New horizons (Baltimore, Md.)
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To review the literature addressing the use of the pulmonary artery catheter (PAC) in patients with cardiovascular disease. ⋯ Pulmonary artery catheterization is often used to optimize patient management, although this may not be demonstrable in terms of prospective trials using mortality or other "hard" outcome measures. Nonetheless, more rapid diagnosis and achievement of therapeutic endpoints guided by PAC use can decrease morbidity and intensive care days.
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To review the literature addressing the issue of a U.S. Food and Drug Administration (FDA) moratorium on use of the pulmonary artery catheter (PAC). ⋯ An FDA moratorium on the use of the PAC is not indicated.
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To review the literature addressing ethical issues related to clinical research and the pulmonary artery catheter (PAC). ⋯ Randomized clinical trails of pulmonary artery catheterization can ethically be conducted.
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To review the literature addressing use of the pulmonary artery catheter (PAC) in patients with sepsis and septic shock. ⋯ Based largely upon expert opinion, PAC use may be appropriate in patients with septic shock unresponsive to early resuscitative measures. Maintenance of normal hemodynamics in this group of patients appears to be the appropriate goal. Research is needed to determine the proper role of the PAC in patients with sepsis/septic shock.
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To review the literature addressing use of the pulmonary artery catheter (PAC) to augment oxygen delivery to supranormal levels in critical illness. ⋯ Further research must be performed before a recommendation can be made about goal-oriented hemodynamic intervention utilizing the PAC to augment oxygen delivery to supranormal levels prior to high-risk surgery. PAC-guided hemodynamic intervention to augment oxygen delivery to supranormal values in patients with SIRS-related organ dysfunction from sepsis, trauma, or postoperative complications is not recommended at this time. Carefully designed, multicenter, randomized, controlled trials are needed to establish whether augmenting oxygen delivery improves organ-specific outcomes and survival under each of these circumstances.