Wednesday, June 14, 2006

Wednesday June 14, 2006
Swan is still very in !!

Lately we had some constant negative studies for pulmonary artery catheter like ESCAPE trial, PAC-MAN study and recently published ARDSnet's FACTT trial 2.

This month Critical Care Medicine published retrospective database analysis of 53,312 trauma patients
1. After all adjustments following groups showed benefit:

  • Patients aged 61-90 yrs,
  • with arrival base deficit worse than -11 and
  • Injury Severity Score of 25-75.

It was found that it was associated with a protective effect in patients with severe shock, regardless of age, and in older patients with moderate shock.

Also note negative outcome: Highest risk of death associated with PAC use was in younger patients who arrived at the ED without a significant base deficit. Moreover, no survival benefit was detected with PAC use in patients arriving at the ED without evidence of shock.

Conclusion: PAC insertion is associated with

  1. improved outcome in critically injured patients with severe shock at admission, regardless of age, and
  2. in elderly patients with moderate shock.

Related previous pearls: PAC-MAN study ! and ESCAPE Trial

Reference: Click to get article

Pulmonary artery catheter use is associated with reduced mortality in severely injured patients: A National Trauma Data Bank analysis of 53,312 patients - Critical Care Medicine. 34(6):1597-1601, June 2006.
Pulmonary-Artery versus Central Venous Catheter to Guide Treatment of Acute Lung Injury - Volume 354:2213-2224, NEJM, May 25, 2006