Hemodynamic assessment: the technique or the physician at fault?

Excerpt

The diagnosis of hemodynamic alterations and the management of acute circulatory failure are a continuous challenge in daily practice. The pulmonary artery catheter (PAC) has long been our main method of diagnosis, but recent studies have challenged its use. In a retrospective study in which a propensity score was used to compare patients Connors et al. [1] observed that the use of the PAC is associated with an increased risk of mortality. The impact of these results was reduced a little by the results of the prospective study by Sandham and colleagues [2] which, although they did not show any benefit associated with PAC use, did not show any harmful effects either. Several factors may explain this lack of efficacy of the PAC, the most important being the fact that it is only a monitoring tool. Hence, while it may be effective to guide therapy, its impact on outcome depends mostly on the effectiveness of the therapies administered. …