From the Guidelines
The disadvantage of using a pulmonary artery catheter to monitor an HDU patient after aortic surgery is an increase in morbidity (option B). Pulmonary artery catheters have been associated with potential complications such as arrhythmias, pulmonary artery rupture, thrombosis, infection, and pneumothorax during insertion, which can lead to increased morbidity in patients 1. The 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery recommends against the routine use of pulmonary artery catheterization in patients, even those with elevated risk, due to the lack of evidence showing improved outcomes 1. Key points to consider include:
- The use of pulmonary artery catheterization may be considered when underlying medical conditions that significantly affect hemodynamics cannot be corrected before surgery 1
- Routine use of pulmonary artery catheterization in patients at elevated surgical risk does not improve outcomes and is not recommended 1
- The largest trial randomly allocated the use of pulmonary artery catheters in 1994 patients at high surgical risk and found no differences in mortality or morbidity, save for an increase in pulmonary embolism noted in the pulmonary artery catheter arm 1. In real-life clinical practice, the risks associated with pulmonary artery catheters often outweigh the benefits, particularly when less invasive monitoring alternatives are available 1.
From the Research
Disadvantages of Pulmonary Artery Catheter in HDU Patient after Aortic Surgery
- The use of pulmonary artery catheters (PACs) in patients after aortic surgery can have several disadvantages, including:
- Increase in morbidity: According to 2, PAC use was associated with an increased infectious morbidity.
- Increase in hospital stay: Although 2 found that PAC use was associated with a decreased length of stay, other studies did not find a significant reduction in hospital stay.
- Complications related to the catheter: Studies such as 3 and 4 found that catheter-related thrombosis and bloodstream infections are potential complications of PAC use.
- It is essential to weigh the potential benefits and risks of using a PAC in each individual patient, considering factors such as the patient's condition, the type of surgery, and the potential for complications.
- The decision to use a PAC should be based on the patient's specific needs and the potential benefits of the catheter, as well as the risks and potential complications associated with its use, as discussed in 5 and 6.