Joseph Corey, Garrubba Marie, Smith Julian A, Melder Angela
Monash Health, Melbourne, Vic, Australia.
Monash Health, Melbourne, Vic, Australia.
Heart Lung Circ. 2018 Aug;27(8):952-960. doi: 10.1016/j.hlc.2018.02.004. Epub 2018 Feb 21.
Pulmonary artery catheters (PACs) were introduced in 1970. Since then, their use has steadily increased. However, there have been questions raised regarding their efficacy for multiple clinical scenarios. The purpose of this systematic review was to determine the safety and effectiveness of routine use of PACs post cardiac surgery on mortality, complications, days in intensive care unit, days in hospital, and costs in patients undergoing cardiac surgery, or patients who end up in an intensive care unit.
Medline, All EBM, EMBASE and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases were searched using predetermined search terms. Google, British Medical Journal (BMJ) Best Practice, and the National Institute for Clinical Excellence (NICE) were also searched. All searches were from 2012 to current to update a previous review from 2013. Studies were included if they involved adult cardiac surgery patients, or intensive care unit (ICU) patients requiring haemodynamic monitoring. All other surgical patients were excluded.
Six articles were included in this review. Of the six articles, five were randomised or observational studies, and one was an expert recommendation. For all cardiac surgery patients and patients having coronary artery bypass grafting, there was no difference in mortality. There was an increase in mortality in high-risk cardiac surgery patients, who had a PAC. For patients following coronary artery bypass grafting, there was no difference in ICU length of stay (LOS) but for patients following cardiac surgery total length of hospital stay >30days was greater in patients with a PAC. For patients following coronary artery bypass grafting, in-hospital costs for the entire hospitalisation were higher in patients with a PAC and, there was no difference in complications between PAC and a central venous catheter use. Overall, PACs were not a predictor of worse outcomes.
This review revealed that PAC use was associated with a poorer outcome in a small subset of cardiac surgical patients but in the majority of patients PAC use made no difference to outcome. Further studies are required to confirm the true safety and efficacy of PAC use in cardiac surgery.
肺动脉导管（PACs）于1970年开始应用。自那时起，其使用量稳步增加。然而，对于其在多种临床情况下的疗效一直存在疑问。本系统评价的目的是确定心脏手术后常规使用PACs对接受心脏手术患者或最终入住重症监护病房的患者的死亡率、并发症、重症监护病房住院天数、住院天数和费用的安全性和有效性。
使用预定的检索词检索Medline、All EBM、EMBASE和护理及联合健康文献累积索引（CINAHL）数据库。还检索了谷歌、《英国医学杂志》（BMJ）最佳实践和国家临床优化研究所（NICE）。所有检索均从2012年至今，以更新2013年的先前综述。纳入的研究需涉及成人心脏手术患者或需要血流动力学监测的重症监护病房（ICU）患者。排除所有其他外科患者。
本综述纳入了6篇文章。在这6篇文章中，5篇为随机或观察性研究，1篇为专家推荐。对于所有心脏手术患者和接受冠状动脉搭桥术的患者，死亡率没有差异。使用PACs的高危心脏手术患者死亡率有所增加。对于接受冠状动脉搭桥术的患者，重症监护病房住院时间（LOS）没有差异，但对于心脏手术后住院总天数>30天的患者，使用PACs的患者住院总天数更长。对于接受冠状动脉搭桥术的患者，使用PACs的患者整个住院期间的住院费用更高，并且使用PACs与使用中心静脉导管之间的并发症没有差异。总体而言，PACs不是预后较差的预测指标。
本综述显示，在一小部分心脏手术患者中，使用PACs与较差的预后相关，但在大多数患者中，使用PACs对预后没有影响。需要进一步研究以证实PACs在心脏手术中使用的真正安全性和有效性。
Zotero 插件