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Pulmonary Artery Catheterization: Developing Guidelines-Reply

C. David Naylor, MD, DPhil; S. Patricia Pinfold, BScN, MSc; William J. Sibbald, MD; Charles L. Sprung, MD; James E. Calvin, MD; Frank B. Cerra, MD
JAMA. 1993;270(16):1933-1934. doi:10.1001/jama.1993.03510160051022.
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In Reply.  —We thank Dr Roizen for his interest and congratulate the ASA panel for their fine work. Their report1 was published in the same period as our article and does meet some of our concerns.We raise, however, the following points:The ASA panel included anesthesiologists; surgeons, internists, and pediatricians were not represented. The guidelines were for perioperative care and did "not address the use of PA [pulmonary artery] catheters in non-surgical settings or by other medical specialties." Thus, many potential indications for pulmonary artery catheterization were not covered.The ASA document does not highlight the specific clinical indications where uncertainty exists about pulmonary artery catheterization and/or where expert opinion allows that randomization could be deemed ethical. Our proposed process would help experts to confront the limited evidence for specific indications and to make their uncertainty manifest in a way that would abet the acquisition of more evidence


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