PA Catheters - Useful or Not
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1 PA Catheters - Useful or Not Perioperative in Liver Transplantation ILTS/ASA, San Francisco, 2003 Claus U. Niemann, MD Department of Anesthesia and Perioperative Division of Liver Transplantation University of California, San Francisco 1
2 Disclaimer Statements made in this presentation reflect the biased opinion of the presenter and does not represent in anyway the opinion of the Anesthesia community 2
3 PA Catheters - Useful or Not Is advanced monitoring efficacious? What is are endpoints to measure efficacy? 3
4 PA Catheters - Useful or Not Advanced monitoring Signal to operator Therapeutic intervention Physiologic Outcomes 4
5 Observational Evidence Adopted from Williams et. al.; Curr Opin Crit Jun;8(3):
6 Randomized, Controlled Trial Evidence Adopted from Williams et. al.; Curr Opin Crit Jun;8(3):
7 Polanczyk et al., JAMA Jul 18;286(3):
8 8
9 9
10 10
11 Comment in: N Engl J Med Jan 2;348(1):66-8. N Engl J Med May 15;348(20):2035-7; author reply N Engl J Med May 15;348(20):2035-7; author reply N Engl J Med May 15;348(20):2035-7; author reply Surg Neurol Mar;59(3): Thorax Mar;58(3):
12 Crit Med Jun;30(6):
13 Before the effectiveness of PA catheters in clinical care can be systematically assessed, efforts are needed to enhance accuracy and consistency of pulmonary artery occlusion pressure estimation. Crit Med Jun;30(6):
14 PA Catheters As a diagnostic tool Detection of left ventricular failure Evaluation of hypotension As a procedural adjunct Goal directed therapy As a teaching tool Appreciation of pathophysiology 14
15 PA Catheters and Liver Transplantation 15
16 PA Catheters and Liver Transplantation PubMed keyword search (limited to humans): Pulmonary artery catheter and liver transplantation 33 articles from 1983 to present Swan-Ganz catheter and liver transplantation 20 articles from 1989 to present 16
17 PA Catheters and Liver Transplantation Schumann, Anesth Analg Jul;97(1):
18 PA Catheters and Liver Transplantation As a diagnostic tool Detection of unrecognized pulmonary HTN before incision Detection of pulmonary embolism 18
19 19
20 PA Catheters and Liver Transplantation As a procedural adjunct Normal/ supra-normal values (Cardiac Output/ oxygen delivery) Management of known pulmonary hypertension Monitoring wedge pressures vs. CVP/PAD 20
21 PA Catheters and Liver Transplantation As a learning tool Appreciate changes in SVR/PVR/CO 21
22 PA Catheters Useful or Not Detection of unrecognized pulmonary HTN before incision Abortion of surgery Referral to pulm HTN clinic Management of known pulmonary hypertension Goal directed therapy As a learning tool 22
23 PA Catheters Useful or Not Optimizing Cardiac Output/hemodynamics Goal directed therapy outcome studies are lacking in this patient population TEE excellent alternative 23
24 PA Catheters Useful or Not Monitoring wedge pressures/ cardiac evaluation TEE provides more information 24
25 Conclusion Application of PA catheters is useful in selected cases TEE is an excellent alternative Outcome studies are presently not available 25
26 The evils of controversy are transitory, while its benefits are permanent R. Hall 1830 (not quite there, yet) Bellomo et al., Curr Opin Crit Jun;9(3):
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