New horizons (Baltimore, Md.)最新文献

{"title":"Training requirements for pulmonary artery catheter utilization in adult patients.","authors":"P J Papadakos,&nbsp;J S Vender","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>To review the literature addressing the issue of training requirements for pulmonary artery catheter (PAC) utilization in adult patients.</p><p><strong>Data source: </strong>All pertinent English language articles dealing with training requirements for pulmonary artery catheterization were retrieved from 1984 through 1997.</p><p><strong>Study selection: </strong>Articles were chosen if issues related to training and pulmonary artery catheterization were studied or reviewed.</p><p><strong>Data extraction: </strong>From the articles selected, information about PAC training was obtained.</p><p><strong>Data synthesis: </strong>The PAC is a commonly employed monitoring tool in the management of critically ill patients. Recent publications have strongly implied that PAC monitoring is associated with an increased morbidity and no notable clinical benefit. In response to these findings, the value of PAC monitoring has been questioned. The benefit assessment of any technology on clinical outcome presumes that the care provider possesses the skills and knowledge to optimally utilize the data obtained and simultaneously minimize the potential complications. Several recent articles have addressed physician and nurse knowledge as it pertains to PAC monitoring. The results of these studies are quite alarming. Marked deficiencies of knowledge were noted particularly in area of data interpretation and patient management. Extrapolating from their conclusions, it appears that any effort to proactively assess the value of PAC monitoring will be compromised until attempts are made to standardize and optimize the clinical skills of those involved in utilization of the technology. This article provides a proposed program for clinical education and raises the question regarding the necessity of demonstrated proficiency.</p><p><strong>Conclusion: </strong>Training, credentialing, and continued quality improvement related to PAC should be improved.</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":"20201046","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 in children.","authors":"A E Thompson","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>To review the literature addressing use of the pulmonary artery catheter (PAC) in pediatric patients.</p><p><strong>Data source: </strong>All pertinent English language articles dealing with the use of pulmonary artery catheterization in pediatric patients were retrieved from 1979 through 1996.</p><p><strong>Study selection: </strong>Articles were chosen for review if the use of pulmonary artery catheterization in pediatric patients was studied or reviewed.</p><p><strong>Data extraction: </strong>From the articles selected, information was obtained about changes in diagnosis, therapy and outcome associated with PAC use in pediatric patients.</p><p><strong>Data synthesis: </strong>The available literature suggests substantial value from the information made available by use of the PAC in a small group of critically ill infants and children.</p><p><strong>Conclusion: </strong>Until there is substantive evidence in children that outcome is negatively affected by their use, PACs should remain available. Experienced physicians should directly supervise PAC insertion and use.</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":"20201168","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 cardiovascular disease.","authors":"S M Hollenberg,&nbsp;J Hoyt","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 cardiovascular disease.</p><p><strong>Data source: </strong>All pertinent English language articles dealing with pulmonary artery catheterization in patients with cardiovascular disease were retrieved from 1976 through 1996.</p><p><strong>Study selection: </strong>Articles were chosen for review if the use of pulmonary artery catheterization in patients with cardiovascular disease 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 cardiovascular disease.</p><p><strong>Data synthesis: </strong>Whether enhanced understanding of patient hemodynamics translates into definable benefits for those patients has recently come into question. Although there are a number of conventional clinical indications for pulmonary artery catheterization, and several studies have shown that catheterization prompts changes in therapy in many patients, most data regarding outcomes are retrospective; prospective randomized trials are lacking. Nonetheless, we believe, based on the available evidence and the preponderance of expert opinion, that management with the PAC improves outcome in several patient populations. These populations include: a) patients with acute myocardial infarction either complicated by cardiogenic shock or progressive hypotension, or associated with mechanical complications; b) patients with congestive heart failure refractory to empiric therapy; c) patients with pulmonary hypertension; and d) patients with shock or hemodynamic instability.</p><p><strong>Conclusion: </strong>Pulmonary artery catheterization is often used to optimize patient management, although this may not be demonstrable in terms of prospective trials using mortality or other \"hard\" outcome measures. Nonetheless, more rapid diagnosis and achievement of therapeutic endpoints guided by PAC use can decrease morbidity and intensive care days.</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":"20201162","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 issue of a U.S. Food and Drug Administration moratorium on the use of 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 the issue of a U.S. Food and Drug Administration (FDA) moratorium on use of the pulmonary artery catheter (PAC).</p><p><strong>Data source: </strong>Pertinent English language articles dealing with medical devices including the PAC were retrieved from 1976 through 1996.</p><p><strong>Study selection: </strong>Articles were chosen if issues related to medical devices were studied or reviewed.</p><p><strong>Data extraction: </strong>From the articles selected, information about the 1976 Medical Device Amendment and the PAC was obtained.</p><p><strong>Data synthesis: </strong>In 1976, the Medical Device Amendment gave the FDA power over medical devices. The pulmonary artery catheter is considered a class II device and was on the market before passage of the 1976 Act. Class II devices require general and specific controls to reasonably assure safety and effectiveness. A reasonable assurance of safety occurs when the probable benefits to health from the use of the device outweigh any probable risks. If a monitor measures an established and well-understood variable and the intended use claim is limited to the measurement of that variable, then the effectiveness consists of determining device safety and performance defined as the measurement of agreement with a recognized reference method. Deaths and serious injuries secondary to pulmonary artery catheterization are extremely rare despite more than 25 years of use. Pulmonary artery catheter manufacturer's indications for use are measurements such as hemodynamic pressures, thermodilution cardiac output, continuous cardiac output, mixed venous oxygen saturation, and blood sampling; intended uses have not included claims of clinical benefit. Evidence exists that pulmonary artery catheterization provides agreement with established measurements including pressure and cardiac output. Evidence also exists that pulmonary artery catheter derived data are unobtainable clinically, that the derived data helps in therapy changes and may lead to more appropriate therapy. The evidence demonstrates an absence of unreasonable risk of injury from pulmonary artery catheterization and provision of important clinical results. Therefore, pulmonary artery catheterization meets FDA requirements for safety and effectiveness.</p><p><strong>Conclusion: </strong>An FDA moratorium on the use of the PAC is not indicated.</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":"20201044","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 Catheter Consensus Conference: consensus statement.","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","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":"20202991","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 catheter consensus conference. Chicago, Illinois, December 6-8, 1996.","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","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":"20306977","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":"Physicians' attitudes toward and knowledge of the pulmonary artery catheter: Society of Critical Care Medicine membership survey.","authors":"S J Trottier,&nbsp;R W Taylor","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>To survey physicians' attitudes toward the pulmonary artery catheter (PAC) and to assess physicians' knowledge of pulmonary artery catheterization.</p><p><strong>Design: </strong>Mail survey/examination.</p><p><strong>Participants: </strong>Physician members of the Society of Critical Care Medicine in the United States.</p><p><strong>Methods: </strong>A 51-question two-part survey was mailed to U.S. Society of Critical Care Medicine physician members by an independent research firm. The participants were instructed to answer the questions unassisted and to return the survey within one month. The first 20 questions surveyed physicians' attitudes toward the PAC. The remaining 31 multiple-choice questions tested the physicians' knowledge of the PAC and its use. The multiple-choice questions were obtained from a previous study which assessed physicians' knowledge of pulmonary artery catheterization.</p><p><strong>Results: </strong>Five thousand surveys were mailed in October of 1996; 1095 surveys were returned in November of 1996, yielding a 22% return rate. The survey results were significant in that 95% of the respondents felt that a moratorium against PAC use was not warranted and that 75% of the respondents favored a prospective, randomized, controlled trial involving pulmonary artery catheterization. The mean test score for the multiple-choice questions was 25.6 (82.6%) with a standard deviation of +/- 3.46 and a range of 3 to 31 (10%-100%). The mean score was found to be significantly associated (p <0.001) with the following variables: specialty, practice pattern, number of PAC insertions performed per month, and whether or not the physician was trained and/or certified in critical care medicine. One third of respondents incorrectly identified the pulmonary artery occlusion pressure on a clear tracing and could not identify the major components of oxygen transport.</p><p><strong>Conclusion: </strong>The results of this mail survey/examination reflect the current attitudes and knowledge of the responding U.S. physician members of the Society of Critical Care Medicine regarding the PAC. The majority of the respondents are in favor of a prospective, randomized, controlled trial involving the PAC; 95% of the respondents feel that a moratorium on further use of the PAC is currently not warranted. Rather than a call for such a moratorium, a call for the development and maintenance of educational, credentialing, and continuous quality improvement policies involving the PAC is warranted and overdue.</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":"20201161","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 new pulmonary artery catheters: continuous venous oximetry, right ventricular ejection fraction, and continuous cardiac output.","authors":"L D Nelson","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>To review the literature addressing the new pulmonary artery catheters: continuous venous oximetry, right ventricular ejection fraction, and continuous cardiac output.</p><p><strong>Data source: </strong>All pertinent English language literature dealing with new pulmonary artery catheters were retrieved from 1981 through 1996.</p><p><strong>Study selection: </strong>Articles were chosen for review if the primary objective of the paper was study or review of technology related to new pulmonary artery catheters.</p><p><strong>Data extraction: </strong>From the literature selected, information was obtained about continuous venous oximetry, right ventricular ejection fraction, and continuous cardiac output catheters.</p><p><strong>Data synthesis: </strong>When pulmonary artery catheterization is used, continuous venous oximetry catheters may be considered for use when it is anticipated that therapy will be based upon oxygen transport end points. When pulmonary artery catheterization is used, right ventricular ejection fraction catheters may be considered for use when the anticipated therapy will be based upon evaluation of ventricular preload and when central venous pressure and/or pulmonary artery occlusion do not accurately reflect preload. When pulmonary artery catheterization is used, continuous cardiac output catheters may be considered for use in titration of interventions employed to alter stroke volume.</p><p><strong>Conclusion: </strong>Clinician misinterpretation and misapplication of the data appear to be the greatest impediment to using pulmonary artery catheterization to alter pathophysiologic processes and improve outcome in critically ill patients. Future research should first document effectiveness or lack of effectiveness of the \"standard\" pulmonary artery catheter (PAC). Pending these results, outcome and cost/benefit studies should be performed comparing \"standard\" with new PACs.</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":"20201040","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 and outcome in the perioperative period.","authors":"A B Leibowitz,&nbsp;Y Beilin","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>To review the literature addressing use of the pulmonary artery catheter (PAC) in the perioperative patient.</p><p><strong>Data source: </strong>All pertinent English language articles dealing with the use of pulmonary artery catheterization in perioperative patients were retrieved from 1977 through 1996.</p><p><strong>Study selection: </strong>Articles were chosen if the perioperative use of pulmonary artery catheterization 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 undergoing cardiac surgery, aortic surgery, peripheral vascular surgery, and neurosurgery. Information was also extracted about perioperative PAC use in geriatric patients and in patients with preeclampsia.</p><p><strong>Data synthesis: </strong>Low-risk patients undergoing cardiac surgery do not appear to benefit from PAC use. Studies looking at high-risk patients undergoing cardiac surgery are lacking, making accurate determination of patient benefit difficult. The PAC may be useful in the management of some patients undergoing aortic surgery, though recent studies have identified populations of patients that can be safely monitored by less invasive means. Use of the PAC may lead to fewer complications in high-risk patients undergoing peripheral vascular surgery. Until data are forthcoming, it is not possible to accurately assess the overall impact of PAC use on complications and mortality in patients undergoing neurosurgical procedures. However, use of the PAC to monitor and treat air embolism in this group of patients does not appear to be appropriate. Routine perioperative use of the PAC does not appear to be appropriate because of age alone. Available scientific data do not support use of the PAC in patients with uncomplicated preeclampsia; however, some experts feel that PAC use may be helpful in the management of selected patients with severe preeclampsia.</p><p><strong>Conclusion: </strong>There are no Grade A indications for PAC use in the perioperative period. Current available literature suffers from a lack of randomized controlled clinical trials. Multicentered randomized controlled trials are needed.</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":"20201163","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":"Introduction to Wolf Creek IV Conference.","authors":"P Safar","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Early milestones of resuscitation research culminated in the 1950s in the documentation of modern external cardiovascular resuscitation (CPR) steps \"ABC,\" followed by advanced and prolonged life support. Implementation of guidelines has been suboptimal. Self-training of the public in life-supporting first aid, including CPR-ABC-available since the 1970s-is only now being re-evaluated and hopefully implemented. Standard external CPR potency is inadequate for reliably restoring spontaneous circulation and saving the brain after prolonged arrests or in patients with sick hearts. Ultra-advanced life-support methods such as open-chest CPR and emergency cardiopulmonary bypass should be tried for bridging standard external CPR-resistant hearts to recovery or repair. Outcome studies in large animals can be fully controlled, in contrast to randomized clinical outcome trials, which have limitations. The HIV paranoia must not lead to abandoning the teaching of steps A and B, which are essential for any kind of coma, asphyxial arrest, and prolonged ventricular fibrillation arrest. Sternal compressions alone can produce some ventilation in animals, but not reliably in comatose humans. For cerebral resuscitation after cardiac arrest, the outcome benefit of the hypertensive bout, other cerebral blood flow-promoting measures, and mild resuscitative hypothermia have been documented in outcome models of large animals and are ready for clinical feasibility trials. The Wolf Creek CPR researchers' conferences I, II, and III were meant to advise the guidelines-setting committees of the American Heart Association and other agencies. The ten topics of Wolf Creek IV, published in this issue of New Horizons, were different in design and objective. There was an appropriate emphasis on fully automatic external defibrillation by lay rescuers, which has the potential for a breakthrough effect. Wolf Creek V, which we recommend to be conducted around the turn of the millennium, should focus on the pathophysiology and therapeutics of respiratory, cardiac, and cerebral resuscitation in general, and on organ, cellular, and molecular level research into how cells, organs, and organisms die, and how acute dying processes might be reversed. What to teach whom and how should be left to guideline conferences of agencies.</p>","PeriodicalId":79357,"journal":{"name":"New horizons (Baltimore, Md.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"1997-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20099842","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}