Long-awaited advances in the treatment of critically ill patients with
shock and acute lung injury are evidenced by recent randomized trials of mortality-reducing
interventions.1- 5 However,
research that strives to change clinical practice is often met with a combination
of celebration, skepticism, and controversy. One continuing controversy concerns
the utility of the quintessential technology of the intensive care unit (ICU):
the pulmonary artery catheter (PAC). The PAC is unique in its multipurpose
role. Used for diagnosis, monitoring, and inexorably linked to goal-directed
therapy, the PAC has shaped how generations of physicians define and treat
critical illness. Indeed, according to a popular critical care textbook, the
PAC is "not just important for the specialty of critical care, it is responsible for the specialty of critical care."6
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