Mendes Ciro Leite, Rezende Ederlon, Dias Fernando Suparregui, Réa-Neto Alvaro
UTI, Hospital de Emergência e Trauma Senador Humberto Lucena.
Serviço de Terapia Intensiva, Hospital do Servidor Público Estadual Francisco Morato de Oliveira, São Paulo, SP.
Rev Bras Ter Intensiva. 2006 Jun;18(2):137-42.
Use of Pulmonary Artery Catheter (PAC) is still a debatable issue, mainly due to questions raised about its security and efficacy. This study reproduced in a sample of Brazilian physicians, another one conducted amidst American doctors, in which was pointed out the heterogeneity of clinical decisions guided by data obtained from PAC.
During the Brazilian Congress of Intensive Care Medicine (Curitiba 2004), doctors were asked to answer a survey form with three vignettes. Each of them contained PAC data and one half of the surveys contained echocardiographic information. Every doctor was asked to select one of six interventions for each vignette. A homogeneous answer was considered when it was selected by at least 80% of the respondents.
Two hundred and thirty seven doctors answered the questionnaires. They selected completely different therapeutic interventions in all three vignettes and none of the interventions achieved more than 80% agreement. Variability persisted with the choices guided by echocardiography.
As in the original study, we observed total heterogeneity of therapeutic interventions guided by CAP and echocardiography. These results could be caused by lack of knowledge about basic pathophysiologic concepts and maybe we had to improve its teaching at the medical school benches.
肺动脉导管（PAC）的使用仍是一个有争议的问题，主要是因为对其安全性和有效性存在质疑。本研究在一组巴西医生中重现了另一项针对美国医生开展的研究，该研究指出了由PAC获得的数据所指导的临床决策的异质性。
在巴西重症医学大会（2004年，库里蒂巴）期间，要求医生回答一份包含三个病例的调查问卷。每个病例都包含PAC数据，且一半的调查问卷包含超声心动图信息。要求每位医生为每个病例选择六种干预措施之一。当至少80%的受访者选择了同一答案时，该答案被视为一致答案。
237名医生回答了问卷。他们在所有三个病例中选择了完全不同的治疗干预措施，且没有一种干预措施的达成率超过80%。在超声心动图指导下的选择中，变异性依然存在。
与原研究一样，我们观察到由PAC和超声心动图指导的治疗干预措施完全异质性。这些结果可能是由于对基本病理生理概念缺乏了解所致，或许我们必须在医学院的教学中加以改进。
