Kirton O C, Civetta J M
Surgical Intensive Care Unit at the University of Miami/Jackson Memorial Medical Center, FL 33101, USA.
New Horiz. 1997 Aug;5(3):222-7.
To review the literature addressing the use of the pulmonary artery catheter (PAC) in victims of blunt and penetrating trauma and examine the available evidence that supports or refutes the claim that PAC use alters outcome in this patient population. Furthermore, to determine what additional research should be done in this area.
All pertinent English language articles dealing with pulmonary artery catheterization in trauma patients were retrieved from 1979 through 1996.
Clinical studies were considered if PACs were used to establish a cardiopulmonary diagnosis, optimize or achieve endpoints of oxygen transport and utilization indices, or guide and/or determine response to therapy. Emphasis was placed on prospective, randomized, controlled trials. However, descriptive case series and retrospectively-analyzed, uncontrolled reviews comprise the majority of available literature.
From these selective studies, information was obtained regarding patient demographics, therapeutic endpoints, and achieved outcome.
Insufficient evidence exists to support a true survival benefit. However, recommendations for indications can be proposed where a reduction in morbidity or improvement in functional outcome is suggested.
Hemodynamic data obtained from the PAC appear to be beneficial for the following indications: a) to ascertain the status of underlying cardiovascular performance and/or the need for improvement; b) to direct therapy when noninvasive monitoring may be inadequate, misleading, or the endpoints of resuscitation difficult to define; c) to assess response to resuscitation; d) to potentially decrease secondary injury when severe closed-head or acute spinal cord injuries are components of multisystem trauma; e) to augment clinical decision-making when major trauma is complicated by severe adult respiratory distress syndrome, progressive oliguria/anuria, myocardial ischemia, congestive heart failure, or major thermal injury; and f) to establish futility of care.
回顾关于肺动脉导管（PAC）在钝性和穿透性创伤患者中应用的文献，并审视支持或反驳PAC应用可改变该患者群体预后这一说法的现有证据。此外，确定该领域还应开展哪些进一步的研究。
检索了1979年至1996年所有涉及创伤患者肺动脉导管插入术的相关英文文章。
若使用PAC来确立心肺诊断、优化或达到氧输送及利用指标的终点，或指导和/或确定对治疗的反应，则纳入临床研究。重点关注前瞻性、随机、对照试验。然而，描述性病例系列以及回顾性分析的非对照综述构成了现有文献的大部分。
从这些选择性研究中，获取了有关患者人口统计学、治疗终点和所取得结局的信息。
尚无充分证据支持真正的生存获益。然而，在提示发病率降低或功能结局改善的情况下，可以提出适应证建议。
从PAC获得的血流动力学数据似乎对以下适应证有益：a）确定潜在心血管功能状态和/或改善的必要性；b）在无创监测可能不足、有误导性或复苏终点难以界定时指导治疗；c）评估对复苏的反应；d）当严重闭合性颅脑损伤或急性脊髓损伤是多系统创伤的组成部分时，可能减少继发性损伤；e）当严重创伤并发严重成人呼吸窘迫综合征、进行性少尿/无尿、心肌缺血、充血性心力衰竭或严重热损伤时，增强临床决策；f）确定治疗的无效性。
