Five years ago in JAMA,1 I
commended the critical care community for beginning in earnest the arduous
process of evaluating the efficacy and effectiveness of pulmonary artery catheterization
(PAC) in the treatment of high-risk surgical patients and critically ill patients
cared for in the intensive care unit (ICU). I deemed this process arduous
because over the years following its introduction in the 1970s, this technology
had found widespread application in the ICU and perioperative setting, despite
a remarkable lack of high-quality evidence supporting such use. An observational
retrospective study published in 1996 suggested PAC use might be associated
with adverse outcome.2 Thus, the proper study
of PAC using prospective randomized study design represented a rigorous and
necessary “back pedaling” from practice current at the time, never
a simple process. In this issue of JAMA, 2 important
articles concerning this evaluation process are published,3,4 making
it timely to revisit recent studies and determine what has been learned.
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