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
- improved outcome in critically injured patients with severe shock at admission, regardless of age, and
- in elderly patients with moderate shock.
Related previous pearls: PAC-MAN study ! and ESCAPE Trial
Reference: Click to get article
1. 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.
2. Pulmonary-Artery versus Central Venous Catheter to Guide Treatment of Acute Lung Injury - Volume 354:2213-2224, NEJM, May 25, 2006