New horizons (Baltimore, Md.)最新文献

{"title":"Right heart catheterization in acute respiratory failure.","authors":"W J Fulkerson,&nbsp;G R Bernard","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>To review the literature addressing the use of the pulmonary artery catheter (PAC) in patients with respiratory failure.</p><p><strong>Data source: </strong>All pertinent English language articles dealing with pulmonary artery catheterization in patients with respiratory failure were retrieved from 1983 through 1996.</p><p><strong>Study selection: </strong>Articles were chosen for review if the use of pulmonary artery catheterization in patients with respiratory failure was studied or reviewed.</p><p><strong>Data extraction: </strong>From the articles selected, information was obtained about changes in therapy and changes in outcome associated with PAC use in patients with respiratory failure.</p><p><strong>Data synthesis: </strong>Evidence exists to suggest that use of the PAC in patients with respiratory failure often results in a change in diagnosis and therapy. Inadequate evidence exists to accurately determine benefit or harm from PAC use in patients with respiratory failure.</p><p><strong>Conclusion: </strong>The optimal role of the PAC as a diagnostic and monitoring device in different types of respiratory failure has not been clearly defined. Research is needed to determine the role of the PAC in very carefully defined groups of patients with respiratory failure.</p>","PeriodicalId":79357,"journal":{"name":"New horizons (Baltimore, Md.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"1997-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20201167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Right heart catheterization: is it effective?","authors":"A F Connors","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objectives: </strong>To discuss the advantages of different methods of determining the effectiveness of healthcare interventions, to evaluate the basis for the assumption that right heart catheterization is effective, and to consider how right heart catheterization may fail to improve outcomes in some circumstances.</p><p><strong>Data source: </strong>Published English language literature on right heart catheterization and patient outcomes.</p><p><strong>Discussion: </strong>We recently reported an association between the use of right heart catheterization in the initial care of critically ill patients and increased risk of death. This finding is troubling and warrants future study. In this article I address the role of randomized controlled trials and observational studies in the evaluation of the effectiveness of healthcare interventions. I discuss the basis in the published literature for assuming that right heart catheterization improves outcomes. Finally I present a variety of problems with right heart catheterization which might allow this procedure, which logically should help patients, to fail to achieve a beneficial effect for some patients.</p><p><strong>Conclusion: </strong>We must do appropriate prospective studies to determine who benefits from right heart catheterization and who does not. We owe our patients nothing less.</p>","PeriodicalId":79357,"journal":{"name":"New horizons (Baltimore, Md.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"1997-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20202992","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Complications associated with pulmonary artery catheterization.","authors":"L A Kelso","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>To review the literature addressing complications associated with pulmonary artery catheterization.</p><p><strong>Data source: </strong>All pertinent English language articles dealing with complications associated with pulmonary artery catheterization were retrieved from 1979 through 1996.</p><p><strong>Study selection: </strong>Articles were chosen for review if the primary objective of the paper was complications associated with pulmonary artery catheterization.</p><p><strong>Data extraction: </strong>From the literature selected, information was obtained about frequency and types of complications associated with pulmonary artery catheterization.</p><p><strong>Data synthesis: </strong>Complications are grouped into three categories: complications associated with insertion, complications associated with indwelling catheters, and complications that occur during or after removal of the catheter.</p><p><strong>Conclusion: </strong>With the introduction of any new technology, there are risks and potential complications. Pulmonary artery catheterization was introduced in 1970 and has not been without complications and controversy. Recent research findings have again led to the discussion of the efficacy and safety of pulmonary artery catheter (PAC) use. This article discusses complications associated with pulmonary artery catheterization and makes recommendations for future research and continued safe use of the PAC.</p>","PeriodicalId":79357,"journal":{"name":"New horizons (Baltimore, Md.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"1997-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20201041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ethical issues of clinical trials for the pulmonary artery catheter.","authors":"C L Sprung,&nbsp;L A Eidelman","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>To review the literature addressing ethical issues related to clinical research and the pulmonary artery catheter (PAC).</p><p><strong>Data source: </strong>All pertinent English language articles dealing with ethical issues related to clinical research and the PAC were retrieved from 1970 through 1996.</p><p><strong>Study selection: </strong>Articles were chosen for review if ethical issues related to clinical research and the PAC were studied or reviewed.</p><p><strong>Data extraction: </strong>From the articles selected, information was obtained about the ethics of clinical research related to the PAC.</p><p><strong>Data synthesis: </strong>Many current procedures and treatments used on a daily basis have not been proven effective by clinical trials. Studies showing increased mortality with the use of PACs are worrisome. Many clinicians have strong preferences about the use of PACs for various indications and there have been difficulties performing clinical trials. Clinical equipoise occurs when competent physicians are content to have their patients receive any of the various treatments in a randomized trial because, based on available data, none has proven preferable. Clinical equipoise for pulmonary artery catheterization for various indications is unknown. If >70% of experts determine that pulmonary artery catheterization is indicated or contraindicated for specific indications, clinical equipoise does not exist and a trial could not ethically be performed for these indications. Indications and contraindications for pulmonary artery catheterization for these indications, however, should be determined. Clinical equipoise would be present if <70% of experts favor pulmonary artery catheterization for a specific indication and trials could be performed in patients with these disorders.</p><p><strong>Conclusion: </strong>Randomized clinical trails of pulmonary artery catheterization can ethically be conducted.</p>","PeriodicalId":79357,"journal":{"name":"New horizons (Baltimore, Md.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"1997-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20201042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The pulmonary artery catheter: economic aspects.","authors":"D B Chalfin","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>To review the literature addressing economic issues related to use of the pulmonary artery catheter (PAC).</p><p><strong>Data source: </strong>All pertinent English language articles related to economic analysis of the use of pulmonary artery catheterization were retrieved from 1977 through 1996.</p><p><strong>Study selection: </strong>Articles were chosen for review if an economic analysis related to use of the PAC was studied or reviewed.</p><p><strong>Data extraction: </strong>From the articles selected, information was obtained about economic aspects related to pulmonary artery catheterization.</p><p><strong>Data synthesis: </strong>Inadequate evidence exists to accurately determine if PAC use is truly cost-effective.</p><p><strong>Conclusion: </strong>Widespread use of the PAC has significant economic ramifications. Data regarding cost-effectiveness of the PAC is extremely limited in terms of methodology and scope. Economic impact and cost-effectiveness are moot prior to establishing clinical efficacy.</p>","PeriodicalId":79357,"journal":{"name":"New horizons (Baltimore, Md.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"1997-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20201047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pulmonary artery catheters in sepsis/septic shock.","authors":"M M Parker,&nbsp;W Peruzzi","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>To review the literature addressing use of the pulmonary artery catheter (PAC) in patients with sepsis and septic shock.</p><p><strong>Data source: </strong>All pertinent English language articles dealing with the use of pulmonary artery catheterization in patients with sepsis and septic shock were retrieved from 1984 through 1996.</p><p><strong>Study selection: </strong>Articles were chosen for review if the use of pulmonary artery catheterization in patients with sepsis/septic shock was studied or reviewed.</p><p><strong>Data extraction: </strong>From the articles selected, information was obtained about changes in therapy and changes in outcome associated with PAC use in patients with sepsis/septic shock.</p><p><strong>Data synthesis: </strong>Inadequate evidence exists to accurately determine if PAC use improves outcome in patients with sepsis/septic shock. Attempting to achieve supranormal hemodynamic variables in patients with septic shock is not warranted.</p><p><strong>Conclusion: </strong>Based largely upon expert opinion, PAC use may be appropriate in patients with septic shock unresponsive to early resuscitative measures. Maintenance of normal hemodynamics in this group of patients appears to be the appropriate goal. Research is needed to determine the proper role of the PAC in patients with sepsis/septic shock.</p>","PeriodicalId":79357,"journal":{"name":"New horizons (Baltimore, Md.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"1997-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20201165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Supranormal oxygen delivery in critical illness.","authors":"G M Matuschak","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>To review the literature addressing use of the pulmonary artery catheter (PAC) to augment oxygen delivery to supranormal levels in critical illness.</p><p><strong>Data source: </strong>All pertinent English language articles dealing with use of the PAC to augment oxygen delivery to supranormal levels in critical illness were retrieved from 1988 through 1996.</p><p><strong>Study selection: </strong>Articles were chosen if material relevant to supranormal oxygen delivery in critically ill patients was studied or reviewed.</p><p><strong>Data extraction: </strong>Methodology of the available studies was analyzed. From the articles selected, information was obtained regarding changes in outcome associated with prospective goal-oriented hemodynamic intervention using a PAC to augment systemic oxygen delivery to supranormal levels prior to high-risk surgery. Patient outcome information was also obtained regarding use of the PAC to augment oxygen delivery to supranormal values begun after the onset of the systemic inflammatory response syndrome (SIRS) following sepsis or trauma.</p><p><strong>Data synthesis: </strong>Inadequate evidence exists to accurately determine if PAC use to augment systemic oxygen delivery improves outcome in either of these circumstances.</p><p><strong>Conclusion: </strong>Further research must be performed before a recommendation can be made about goal-oriented hemodynamic intervention utilizing the PAC to augment oxygen delivery to supranormal levels prior to high-risk surgery. PAC-guided hemodynamic intervention to augment oxygen delivery to supranormal values in patients with SIRS-related organ dysfunction from sepsis, trauma, or postoperative complications is not recommended at this time. Carefully designed, multicenter, randomized, controlled trials are needed to establish whether augmenting oxygen delivery improves organ-specific outcomes and survival under each of these circumstances.</p>","PeriodicalId":79357,"journal":{"name":"New horizons (Baltimore, Md.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"1997-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20201166","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pulmonary artery catheterization: a narrative and systematic critique of randomized controlled trials and recommendations for the future.","authors":"R I Ivanov,&nbsp;J Allen,&nbsp;J D Sandham,&nbsp;J E Calvin","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>The purpose of this review is to evaluate the current literature regarding the efficacy of pulmonary artery catheterization, to assess the quality of existing randomized controlled trials and to make recommendations for future studies.</p><p><strong>Data source: </strong>A Medline search was conducted of English language studies published between 1970 and 1996 using as search terms \"Swan-Ganz catheterization,\" \"pulmonary artery catheterization,\" and \"right heart catheterization.\"</p><p><strong>Study selection: </strong>Randomized controlled trials of pulmonary artery catheterization were selected for review. Sixteen randomized controlled trials were identified.</p><p><strong>Data extraction: </strong>The quality of the randomized controlled trials was assessed and a formal meta-analysis was performed.</p><p><strong>Data synthesis: </strong>The overall quality score was 40.15 +/- 6.32 out of a possible score of 100. Serious deficiencies were identified including a lack of a priori sample size calculations, unclear definitions of concomitant therapy, inability to blind physicians and patients, and lack of blinded outcome assessments. A random effects model found the relative risk ratio of .808 (95% confidence interval [CI] = .598, 1.091; p = .148). An analysis of potential covariates revealed patients from surgical series treated with pulmonary artery catheter (PAC)-guided therapy had a relative risk ratio of .578 (95% CI = .357, .937; p = .03) compared with control groups. Patients from medical or mixed unit series had a relative risk of 1.043 (95% CI = .784, 1.387; p = NS).</p><p><strong>Conclusion: </strong>Existing randomized controlled trials on PAC-guided strategies reveal a modest risk reduction that does reach statistical significance. Risk reduction appears to be greatest in surgical series. Deficiencies of these trials have important implications for the proper design of future trials.</p>","PeriodicalId":79357,"journal":{"name":"New horizons (Baltimore, Md.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"1997-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20201043","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Do pulmonary artery catheters alter outcome in trauma patients?","authors":"O C Kirton,&nbsp;J M Civetta","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>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.</p><p><strong>Data source: </strong>All pertinent English language articles dealing with pulmonary artery catheterization in trauma patients were retrieved from 1979 through 1996.</p><p><strong>Study selection: </strong>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.</p><p><strong>Data extraction: </strong>From these selective studies, information was obtained regarding patient demographics, therapeutic endpoints, and achieved outcome.</p><p><strong>Data synthesis: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":79357,"journal":{"name":"New horizons (Baltimore, Md.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"1997-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20201164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is nursing education adequate for pulmonary artery catheter utilization?","authors":"T S Ahrens","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>To review the literature addressing the nursing education of pulmonary artery catheterization.</p><p><strong>Data source: </strong>All pertinent English language articles dealing with nursing education and pulmonary artery catheterization were retrieved from 1983 through 1996.</p><p><strong>Study selection: </strong>Clinical studies related to nursing education in this field were selected. Only two studies addressing nursing knowledge of pulmonary artery catheterization have been published to date.</p><p><strong>Data extraction: </strong>Both studies suggest that an improvement in several areas of nursing knowledge is necessary. Unfortunately, these studies are limited in scope and depth.</p><p><strong>Data synthesis: </strong>The adequacy of nursing education in hemodynamic monitoring, ranging from cognitive to technical issues, has not been addressed in a systematic fashion in the literature.</p><p><strong>Conclusion: </strong>Nurses need a standardized hemodynamic monitoring curriculum. At present, education of nurses is primarily institutionally based. While national guidelines exist for hemodynamic monitoring, no mechanisms are in place to verify the skills of individual nurses. Since physicians depend on the knowledge and skill of the bedside nurse to obtain accurate information, any study evaluating the impact of pulmonary artery catheterization should first control for nursing knowledge. Since this information is not currently known, the precise impact of pulmonary artery catheterization cannot be assessed at this time.</p>","PeriodicalId":79357,"journal":{"name":"New horizons (Baltimore, Md.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"1997-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20201045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}