Procon clinical debate pulmonary artery catheters increase the morbidity and mortality of intensive care unit patients 英文参考文献.docVIP

Available online /content/7/2/101 Commentary Pro/con clinical debate: Pulmonary artery catheters increase the morbidity and mortality of intensive care unit patients Stephen E Lapinsky1 and Guy A Richards2 1Associate Director, Intensive Care Unit, Mount Sinai Hospital and Interdisciplinary Division of Critical Care, University of Toronto, Canada 2Director of Intensive Care, Johannesburg Hospital and Associate Professor, Department of Medicine, University of the Witwatersrand, Johannesburg, South Africa Correspondence: Critical Care Forum Editorial Office, editorial@ Published online: 24 December 2002 Critical Care 2002, 7:101-103 (DOI 10.1186/cc1872) This article is online at /content/7/2/101 ? 2003 BioMed Central Ltd (Print ISSN 1364-8535; Online ISSN 1466-609X) Abstract One of the highlights of the intensive care unit when I was a resident was the opportunity to place a pulmonary artery catheter and then spend the rest of the day calculating parameters such as oxygen delivery, oxygen consumption, intrapulmonary shunt fraction, and so on. I have noticed in the past few years that the use of these devices in our unit is much less frequent. In our case I am not absolutely certain of the reason for this. Perhaps with time our clinical sense has improved to the point that we do not need the data available, perhaps other tests have replaced the pulmonary artery catheter’s role or perhaps we are worried about the possible morbidity/mortality associated with its use. In the present article, we revisit this important debate. Keywords hemodynamics, pulmonary artery catheterization, pulmonary wedge pressure, Swan-Ganz catheterization The scenario A 35-year-old woman is in the intensive care unit (ICU) with abdominal sepsis secondary to a perforated bowel. Complications include acute respiratory distress syndrome and hypotension, requiring mechanical ventilation and inotropes, respectively. The only worrying laboratory values are a doubling of the patien