Articles: monitoring.
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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 new pulmonary artery catheters: continuous venous oximetry, right ventricular ejection fraction, and continuous cardiac output. ⋯ Clinician misinterpretation and misapplication of the data appear to be the greatest impediment to using pulmonary artery catheterization to alter pathophysiologic processes and improve outcome in critically ill patients. Future research should first document effectiveness or lack of effectiveness of the "standard" pulmonary artery catheter (PAC). Pending these results, outcome and cost/benefit studies should be performed comparing "standard" with new PACs.
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To review the literature addressing use of the pulmonary artery catheter (PAC) in the perioperative patient. ⋯ There are no Grade A indications for PAC use in the perioperative period. Current available literature suffers from a lack of randomized controlled clinical trials. Multicentered randomized controlled trials are needed.