Pulmonary artery catheters

Pulmonary artery catheters for adult patients in intensive care: a systematic review of the literature and meta-analysis

What was this review about? 

A pulmonary artery catheter (PAC) is a device utilised in intensive care units to measure the pressures in the heart and lung blood vessels and to monitor patients. 

The catheter is inserted into the right side of the heart through a line placed in a large blood vessel in the neck or groin and is positioned into the pulmonary artery. 

Complications are uncommon and are mainly related to line insertion. Occasionally bleeding inside the lung and changes in heart rhythm have been reported, but death associated with a PAC is rare. 

This Cochrane systematic review looked at randomised trials comparing management with and without a PAC. The objective was to provide an up-to-date assessment of evidence on the effectiveness of PAC on death rates, days spent in the intensive care unit, days spent in hospital, and cost of care for adult patients in intensive care. 

What did the review find? 

The review identified 12 trials involving 4686 patients.

There was no difference in death rates, days spent in the intensive care unit, and days spent in hospital between patients who did and did not have a PAC inserted. 

Two US studies were analysed for hospital cost associated with management or without a PAC and showed no difference in the cost. 

Neither group of patients studied showed any evidence of benefit or harm from using a PAC. 

The authors recommended that studies needed to be conducted to identify subgroups of intensive care unit patients who can benefit, when the device is used in combination with standardised treatment plans, in reversing shock states and improving organ function. 

A subsequent update identified one additional trial bringing the total number of patients involved to 5686. The conclusions were unchanged.

Publications

  • Authors: Rajaram SS, Desai NK, Kalra A, Gajera M, Cavanaugh SK, Brampton W, Young D, Harvey S, Rowan K Title: Pulmonary artery catheters for adult patients in intensive care Publication: Cochrane Database of Systematic Reviews Journal website PubMed citation
  • Authors: Harvey S, Young D, Brampton W, Cooper AB, Doig G, Sibbald W, Rowan K Title: Pulmonary artery catheters for adult patients in intensive care Publication: Anesthesia & Analgesia Journal website
  • Authors: Harvey S, Young D, Brampton W, Cooper AB, Doig G, Sibbald W, Rowan K Title: Pulmonary artery catheters for adult patients in intensive care Publication: Cochrane Database of Systematic Reviews Journal website PubMed citation