Do Critically Ill Patients Benefit From Use of Pulmonary Artery Catheters?

To the Editor: In his Editorial on pulmonary artery catheters (PACs), Dr Hall¹ stated that "there are no studies in the medical literature that demonstrate a benefit for PAC use in . . . the perioperative patient." Hall may be unaware of the difficulties posed by perioperative care for patients with abdominal aortic aneurysm in the 1960s and 1970s before the advent of the PAC, echocardiography, and most of the advanced cardiac pharmacotherapy we now use. At that time, the volume status of a patient with abdominal aortic aneurysm was very difficult to discern, especially when the patient was hypothermic at the time that volume shifts were occurring. I am just old enough to have seen patients develop severe renal failure because of an erroneous impression that patients were "wet" when they were really "dry," and central venous pressure measurements were usually useless in this circumstance. I have seen the volume swings that patients would experience when diuretics were given, causing hypotension, followed by an unnecessary infusion of crystalloid to restore fluids, all of this exacerbating an underlying hyponatremia.