LONDON, Aug. 5 - Using pulmonary artery catheters for hemodynamic monitoring of patients in the intensive care unit neither improves nor decreases mortality rates, reported investigators here.

In the PAC-Man study, which involved more than 1,000 patients treated in more than 20% of all intensive care units in Britain, investigators found no statistically significant differences in mortality between patients who were managed with pulmonary artery catheters and those who went without.

About 10% of the patients who received pulmonary artery catheters had complications associated with insertion of the catheters, including hematomas, arterial punctures, arrhythmias, and one cardiac arrest, but none was fatal, Shelia Harvey, M.Sc. from the Intensive Care National Audit and Research Center and colleagues reported in the Aug. 6 issue of The Lancet.
First proposed in the late 1940s, pulmonary artery catheters have been widely used in critically ill patients for the past three decades, but there has been little hard, unbiased evidence to document their clinical effectiveness, the authors noted.

"No monitoring device has polarized opinion as much as the pulmonary artery catheter," they wrote. "Proponents argue that its unique ability to allow accurate measurement of cardiac output and other hemodynamic variables enables improved diagnosis and management of circulatory instability. Critics, however, point to complications associated with its insertion and use, inaccuracies in measurement, and difficulties with interpretation of data. Furthermore, a lack of positive outcome benefits in the critically ill and some suggestions of increased mortality from retrospective analyses indicate potential problems with this device."

In an accompanying editorial, Bruno Simini, M.D., of the Ospedale Generale Provincale in Lucca, Italy, said the findings of this trial should put to rest the controversy over the use of pulmonary artery catheters in the ICU -- or at least change how and when they are used.

"Clinicians who took part in this study will probably insert fewer catheters, or, as the authors conclude, they will look for subgroups of patients (if any) for whom these devices might prove useful. Or they will look for a better use of the information gained with these catheters," Dr. Simini wrote.

To determine whether the use of pulmonary artery catheters in the ICU actually had an effect on in-hospital mortality, the investigators conducted a randomized study involving 1,041 critically ill patients from 65 ICUs throughout the Britain.

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