Pulmonary artery catheterization--uses and abuses.

Pulmonary artery (PA) catheterization has been extensively employed in the care of the critically ill and injured patients. As the clinical experience has increased, so has the list of indications and complications. Doubts have arisen as to the appropriateness of PA catheterization and positive contributions to patients care. Consensus can be reached as to the usefulness of PA catheterization in patients with severe shock syndromes, adult respiratory distress syndrome and refractory cardiac failure. Patients who require large doses of vasoactive agents may benefit from assessment of hemodynamics. Patients with minimal disease or easily correctable hypovolemia can be safely managed without PA catheter. Similarly patients with chronic obstructive pulmonary disease and renal failure requiring dialysis rarely need PA catheterization. Since technical, septic and thromboembolic complications can develop in a significant number of patients, cost benefit oriented analysis in various subsets of patients is needed. Diagnostic information derived from PA catheters should be related to the clinical condition and shortcomings and pitfalls of data clearly understood. Various indications and their relevance to patient care is reviewed.