What are the disadvantages of using a pulmonary artery catheter in a post-aortic surgery patient?

From the Guidelines

The disadvantage of a pulmonary artery catheter in an HDU patient who had aortic surgery is an increase in morbidity (option B). Pulmonary artery catheters, while providing valuable hemodynamic data including cardiac output, pulmonary artery pressures, and mixed venous oxygen saturation, are associated with several complications that can increase patient morbidity, as noted in the 2019 guidelines on cardiopulmonary bypass in adult cardiac surgery 1. These complications include arrhythmias during insertion, pulmonary artery rupture, pulmonary infarction, thrombosis, infection, and pneumothorax. Research has shown that despite the detailed hemodynamic information these catheters provide, they don't necessarily improve patient outcomes and can lead to iatrogenic complications, with a recent retrospective observational study showing a higher incidence of prolonged mechanical ventilation and length of stay beyond 30 days in patients receiving the PAC 1. The increased morbidity stems from both mechanical complications during insertion and maintenance as well as potential misinterpretation of the data leading to inappropriate interventions. While pulmonary artery catheters remain useful in specific clinical scenarios, their routine use has declined due to recognition of these risks and the development of less invasive monitoring alternatives, as also recommended by the 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery 1. Key points to consider include:

• The lack of evidence about the balance of benefits and complications during cardiac surgery 1
• The potential for technical errors and iatrogenic complications 1
• The recommendation against routine use of pulmonary artery catheterization in patients, even those with elevated risk 1

From the Research

Disadvantages of Pulmonary Artery Catheter

• Increase in morbidity: The use of pulmonary artery catheters (PACs) has been associated with an increased risk of infectious morbidity 2 and cardiopulmonary morbidity 3.
• Increase in hospital stay: Although one study found that PAC use was associated with a decreased length of stay 2, another study found that intensive care unit length of stay was longer in patients with PAC insertion 4.
• Other disadvantages:
  • Increased risk of intraoperative complications 3
  • Increased risk of catheter-related thrombosis 5
  • Potential for limited benefit in cardiac surgery 4

Specific Disadvantages Relevant to the Question

• The options A (Increase in mortality) and D (Increase in Hospital stay) are not consistently supported by the evidence as disadvantages of pulmonary artery catheter use in the context of aortic surgery.
• Option C (Increase HDU stay) is not directly addressed in the provided studies, but option B (Increase morbidity) is supported by the evidence as a potential disadvantage of pulmonary artery catheter use.