Eisenberg P R, Jaffe A S, Schuster D P
Crit Care Med. 1984 Jul;12(7):549-53. doi: 10.1097/00003246-198407000-00001.
Although pulmonary artery (PA) catheterization is frequently employed in the management of critically ill patients, there is little documentation that the information obtained alters patient management. This study evaluated prospectively this question in 103 PA catheterizations. Before catheterization, physicians were asked to predict the range of several hemodynamic variables, the presumed diagnosis, and their plan for therapy. After catheterization, each chart was reviewed. The hemodynamics at the time of catheterization and therapy within 8 h of catheterization were noted. Pulmonary artery occlusive (wedge) pressure (WP) was correctly predicted 30% of the time. Cardiac output, systemic vascular resistance (SVR), and right atrial pressure (RAP) were correctly predicted approximately 50% of the time. There was no significant difference in the ability to predict hemodynamics of subgroups with either hypotension or impaired oxygenation. After catheterization, planned therapy was altered in 58% of the cases. Unanticipated therapy was added in 30% of the cases. This study documents the difficulty of predicting accurately hemodynamics based solely on clinical evaluation. Thus, the information obtained by catheterization often leads to alterations in the therapeutic plan. We suggest that PA catheterization is both indicated and useful in the management of critically ill patients.
尽管肺动脉导管插入术常用于危重症患者的治疗，但几乎没有文献证明所获取的信息会改变患者的治疗方案。本研究前瞻性地评估了103例肺动脉导管插入术的这一问题。在进行导管插入术前，要求医生预测几个血流动力学变量的范围、推测的诊断以及他们的治疗计划。导管插入术后，对每份病历进行审查。记录导管插入时的血流动力学情况以及导管插入术后8小时内的治疗情况。肺动脉闭塞（楔压）（WP）的预测准确率为30%。心输出量、全身血管阻力（SVR）和右心房压力（RAP）的预测准确率约为50%。对于低血压或氧合受损的亚组，预测血流动力学的能力没有显著差异。导管插入术后，58%的病例改变了计划的治疗方案。30%的病例增加了意外的治疗。本研究证明了仅基于临床评估准确预测血流动力学的困难。因此，通过导管插入术获得的信息常常会导致治疗方案的改变。我们认为肺动脉导管插入术在危重症患者的治疗中既适用又有用。
