To the Editor: In the Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness (ESCAPE) trial, Dr Stevenson and colleagues1 showed that the addition of the pulmonary artery catheter (PAC) to “clinical assessment alone” in the treatment of decompensated heart failure did not affect overall mortality and hospitalization. This finding of no effect could have been explained in part by use of continuous central venous pressure (CVP) monitoring via indwelling central venous lines other than PACs among participants randomized to receive therapy guided by clinical assessment alone. In the absence of pulmonary hypertension or profound right ventricular dysfunction, CVP provides a reasonable estimation of left ventricular filling characteristics.2 - 3 Serial measurements of CVP may provide useful information about response to treatment of volume overload.4
It would be helpful for the authors to describe the use of central lines and CVP monitoring among participants in each study group, including use after the PAC was removed in those who were randomized to receive a PAC. It is important to know whether clinical assessment alone included invasive monitoring with its attendant risks and potential, but unproved, benefits in the study population.
Financial Disclosures: None reported.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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