What is the role of pulmonary artery catheters in the diagnosis and management of acute respiratory distress syndrome (ARDS)?

Updated: Mar 27, 2020
  • Author: Eloise M Harman, MD; Chief Editor: Michael R Pinsky, MD, CM, Dr(HC), FCCP, FAPS, MCCM  more...
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Answer

Although pulmonary artery catheters provide considerable information, their use is not without controversy. The ARDS Clinical Trials Network studied whether a difference in mortality could be found in ARDS patients whose fluid management was guided by pulmonary artery catheter versus central venous catheter after initial resuscitation. [22] The study found no difference in mortality, ventilator days, ICU days, or need for pressors or dialysis The pulmonary artery catheter group had twice as many catheter-related complications, primarily arrhythmias. Still, more patients were excluded from the study because they had already received a pulmonary artery catheter than were randomized into both groups combined. And, when the nonrandomized patients were studied, their mortality was similar to both control groups.

Another large retrospective study of critically ill patients monitored with pulmonary artery catheters in the first 24 hours of ICU admission showed that patients with pulmonary artery catheters had an increased mortality rate, hospital cost, and length of stay compared with a retrospectively developed matched patient group managed without them. [23] Thus, use of the generic pulmonary artery catheter past the time of initial resuscitation confers no survival benefit and possibly has an adverse effect on survival.


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