The pulmonary artery catheter (PAC) is widely used in critically ill
patients, but whether it improves outcomes is not clear. Results from 2 studies
reported in this issue of JAMA address this question.
In the first article from the Evaluation Study of Congestive
Heart Failure and Pulmonary Artery Catheterization Effectiveness (ESCAPE)
trialArticle, the investigators found that patients who were randomly assigned to
treatment guided by PAC monitoring and clinical assessment vs clinical assessment
alone had similar hospital days and mortality but experienced more in-hospital
adverse events. In the second article, Shah and colleaguesArticle report results of a meta-analysis of data from 13 clinical trials in which patients were randomly assigned to receive PAC or not to receive PAC. They
found that in the patient groups studied—surgical patients, intensive
care unit admissions for sepsis, patients with acute respiratory distress
or advanced heart failure—the PAC had a neutral effect on mortality
and hospital days. In an editorial, HallArticle discusses
the evidence for and against widespread use of PACs in critically ill patients.