Division of Pulmonary and Critical Care Medicine, Eastern Virginia Medical School, 825 Fairfax Avenue, Suite 410, Norfolk, VA, USA.
Ann Intensive Care. 2013 Nov 28;3(1):38. doi: 10.1186/2110-5820-3-38.
The birth of the intermittent injectate-based conventional pulmonary artery catheter (fondly nicknamed PAC) was proudly announced in the New England Journal of Medicine in 1970 by his parents HJ Swan and William Ganz. PAC grew rapidly, reaching manhood in 1986 where, in the US, he was shown to influence the management of over 40% of all ICU patients. His reputation, however, was tarnished in 1996 when Connors and colleagues suggested that he harmed patients. This was followed by randomized controlled trials demonstrating he was of little use. Furthermore, reports surfaced suggesting that he was unreliable and inaccurate. It also became clear that he was poorly understood and misinterpreted. Pretty soon after that, a posse of rivals (bedside echocardiography, pulse contour technology) moved into the neighborhood and claimed they could assess cardiac output more easily, less invasively and no less reliably. To make matter worse, dynamic assessment of fluid responsiveness (pulse pressure variation, stroke volume variation and leg raising) made a mockery of his 'wedge' pressure. While a handful of die-hard followers continued to promote his mission, the last few years of his existence were spent as a castaway until his death in 2013. His cousin (the continuous cardiac output PAC) continues to eke a living mostly in cardiac surgery patients who need central access anyway. This paper reviews the rise and fall of the conventional PAC.
间歇推注型传统肺动脉导管（简称 PAC）于 1970 年在《新英格兰医学杂志》上由其父母 HJ Swan 和 William Ganz 自豪地宣布诞生。PAC 迅速成长，于 1986 年步入成年，在美国，有超过 40%的 ICU 患者的治疗方案受到了他的影响。然而，1996 年，Connors 及其同事的研究表明 PAC 可能对患者造成伤害，他的声誉因此受损。随后的随机对照试验表明他的作用有限。此外，有报道称 PAC 不可靠且不准确。人们还逐渐认识到 PAC 难以理解和容易被误解。就在那之后，一批竞争对手（床边超声心动图、脉搏轮廓技术）进入该领域，并声称他们可以更轻松、更微创、更可靠地评估心输出量。更糟糕的是，对液体反应性的动态评估（脉压变化、每搏量变化和抬腿试验）使得 PAC 的“楔压”显得荒谬。尽管少数顽固的追随者仍继续推崇他的使命，但他的余生却在被放逐中度过，直到 2013 年去世。他的表亲（连续心输出量 PAC）继续在需要中央通路的心脏手术患者中艰难求生。本文回顾了传统 PAC 的兴衰历程。
