J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website http://www.jocmr.org

Review

Volume 8, Number 11, November 2016, pages 769-776

The Use of Pulmonary Artery Catheter in Sepsis Patients: A Literature Review

**Table 1.** Clinical Studies Evaluating the Role of the Pulmonary Artery Catheter in Patients With Sepsis or Septic Shock
Author/year	Origin/year	Study design	Findings
CCO(PAC): continuous cardiac output by PAC; ICU: intensive care unit; LOS: length of stay; PAC: pulmonary artery catheter; pts: patients; RCT: randomized controlled trial.
Gopal et al, 2014 [4]	Wolverhampton, UK	Prospective observational study, 22 pts with septic shock	Non-invasive cardiac output monitoring had high error rate compared to thermodilution using PAC.
Slagt et al, 2013 [5]	Zaandam, Netherlands	Prospective observational study, 19 pts with septic shock	Strong correlation between cardiac output measurements using thermodilution with PAC (COtd) vs. the FloTrac/VigileoTM (COfv). COfv underestimates COtd in septic shock with low SVR.
Trof et al, 2012 [6]	Amsterdam, Netherlands	RCT, 120 pts	Important outcomes, including ventilator-free days, LOS, organ failure and mortality not significantly different with PAC use.
Bethlehem et al, 2012 [7]	Leeuwarden, Netherlands	Retrospective study, 140 sepsis pts	Comparison before vs. after introducing PAC based protocol in sepsis: PAC use was associated with higher vasopressor use, higher first day but lower overall IV fluid use and reduced ventilator and ICU days.
Spohr et al, 2007 [8]	Heidelberg, Germany	Prospective cohort study, 14 pts with septic shock	Excellent correlation between CCO(PAC) vs. pulse-contour analysis using PiCCO system (r² = 0.714, P < 0.0001), but limited precision of single CCO(PCCO) measurements vs. CCO(PAC).
Siddiqui, 2005 [9]	Karachi, Pakistan	Retrospective chart review, 10 pts	No complications related to PAC use, but nine of 10 pts died of severe sepsis.
ARDSNet Group, 2006 [10, 11]	Nashville, TN, USA	Fluid and Catheter Treatment Trial (FACTT)	PAC-guided therapy was associated with higher incidence of complications and no improvement in survival. Conservative fluid management improved lung function and resulted in shorter mechanical ventilation and ICU stay.
Shah et al, 2005 [12]	New York, NY USA	Meta-analysis of 13 RCTs from 1985 to 2005	PAC use does not seem to increase mortality or LOS. However, because clinical trials exclude patients for whom a PAC is required, patients excluded from these trials could perhaps benefit from PAC.
Richard et al 2003 [13]	Paris, France	RCT, 36 ICUs, 676 pts	PAC use did not affect morbidity or mortality in ARDS, PAC related infection observed in 10 patients (2.8%).
Yu et al, 2003 [14]	Boston, MA, USA	Case-control within prospective cohort, 1,010 ICU admissions in adults with sepsis	Patients with PAC had slightly (but not significantly) lower mortality and hospital charges, but significantly higher risk of renal failure within 28 days.
Chen et al, 2003 [15]	Taipei, Taiwan, ROC	RCT, 258 pts	Risk of catheter colonization and bacteremia not significantly different when PAC used for 4 vs. 7 days.
Rhodes, 2002 [20]	London, UK	RCT, 201 ICU pts (including 101 pts with sepsis)	Patients in the PAC group received significantly more fluids in the first 24 h, had significantly higher renal failure and thrombocytopenia, but there was no difference in mortality.
Sakka et al, 2000 [16]	Jena, Germany	Prospective study, 12 sepsis or septic shock ICU pts	PAC use not justified solely for CO measurement, because CO can be obtained with similar accuracy from non-invasive methods.
Connors et al, 1996 [17]	Cleveland, OH, USA	Prospective cohort study, 5,735 ICU pts	PAC use associated with increased resource utilization, higher mortality in several subgroups, including patients with sepsis.
Schoenenberger et al, 1995 [18]	Basel, Switzerland	Prospective study, 47 pts	Data obtained after PAC insertion resulted in major change of treatment plan in 21% of patients.
Jardin et al, 1994 [19]	Boulogne, France	Prospective study, 32 pts	Comparing invasive (using PAC) vs. non-invasive (using echocardiography) hemodynamic evaluation in sepsis. PCWP unreliable index of preload, possible overestimation of cardiac output using thermodilution.

Table 1. Clinical Studies Evaluating the Role of the Pulmonary Artery Catheter in Patients With Sepsis or Septic Shock

Author/year

Origin/year

Study design

Findings

CCO(PAC): continuous cardiac output by PAC; ICU: intensive care unit; LOS: length of stay; PAC: pulmonary artery catheter; pts: patients; RCT: randomized controlled trial.

Gopal et al, 2014 [4]

Wolverhampton, UK

Prospective observational study, 22 pts with septic shock

Non-invasive cardiac output monitoring had high error rate compared to thermodilution using PAC.

Slagt et al, 2013 [5]

Zaandam, Netherlands

Prospective observational study, 19 pts with septic shock

Strong correlation between cardiac output measurements using thermodilution with PAC (COtd) vs. the FloTrac/VigileoTM (COfv). COfv underestimates COtd in septic shock with low SVR.

Trof et al, 2012 [6]

Amsterdam, Netherlands

RCT, 120 pts

Important outcomes, including ventilator-free days, LOS, organ failure and mortality not significantly different with PAC use.

Bethlehem et al, 2012 [7]

Leeuwarden, Netherlands

Retrospective study, 140 sepsis pts

Comparison before vs. after introducing PAC based protocol in sepsis: PAC use was associated with higher vasopressor use, higher first day but lower overall IV fluid use and reduced ventilator and ICU days.

Spohr et al, 2007 [8]

Heidelberg, Germany

Prospective cohort study, 14 pts with septic shock

Excellent correlation between CCO(PAC) vs. pulse-contour analysis using PiCCO system (r² = 0.714, P < 0.0001), but limited precision of single CCO(PCCO) measurements vs. CCO(PAC).

Siddiqui, 2005 [9]

Karachi, Pakistan

Retrospective chart review, 10 pts

No complications related to PAC use, but nine of 10 pts died of severe sepsis.

ARDSNet Group, 2006 [10, 11]

Nashville, TN, USA

Fluid and Catheter Treatment Trial (FACTT)

PAC-guided therapy was associated with higher incidence of complications and no improvement in survival.
Conservative fluid management improved lung function and resulted in shorter mechanical ventilation and ICU stay.

Shah et al, 2005 [12]

New York, NY USA

Meta-analysis of 13 RCTs from 1985 to 2005

PAC use does not seem to increase mortality or LOS. However, because clinical trials exclude patients for whom a PAC is required, patients excluded from these trials could perhaps benefit from PAC.

Richard et al 2003 [13]

Paris, France

RCT, 36 ICUs, 676 pts

PAC use did not affect morbidity or mortality in ARDS, PAC related infection observed in 10 patients (2.8%).

Yu et al, 2003 [14]

Boston, MA, USA

Case-control within prospective cohort, 1,010 ICU admissions in adults with sepsis

Patients with PAC had slightly (but not significantly) lower mortality and hospital charges, but significantly higher risk of renal failure within 28 days.

Chen et al, 2003 [15]

Taipei, Taiwan, ROC

RCT, 258 pts

Risk of catheter colonization and bacteremia not significantly different when PAC used for 4 vs. 7 days.

Rhodes, 2002 [20]

London, UK

RCT, 201 ICU pts (including 101 pts with sepsis)

Patients in the PAC group received significantly more fluids in the first 24 h, had significantly higher renal failure and thrombocytopenia, but there was no difference in mortality.

Sakka et al, 2000 [16]

Jena, Germany

Prospective study, 12 sepsis or septic shock ICU pts

PAC use not justified solely for CO measurement, because CO can be obtained with similar accuracy from non-invasive methods.

Connors et al, 1996 [17]

Cleveland, OH, USA

Prospective cohort study, 5,735 ICU pts

PAC use associated with increased resource utilization, higher mortality in several subgroups, including patients with sepsis.

Schoenenberger et al, 1995 [18]

Basel, Switzerland

Prospective study, 47 pts

Data obtained after PAC insertion resulted in major change of treatment plan in 21% of patients.

Jardin et al, 1994 [19]

Boulogne, France

Prospective study, 32 pts

Comparing invasive (using PAC) vs. non-invasive (using echocardiography) hemodynamic evaluation in sepsis. PCWP unreliable index of preload, possible overestimation of cardiac output using thermodilution.