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Assessment of the clinical effectiveness of pulmonary artery catheters in management of patients in intensive care (PAC-Man): a randomised controlled trial.

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Title: Assessment of the clinical effectiveness of pulmonary artery catheters in management of patients in intensive care (PAC-Man): a randomised controlled trial.
Authors: Harvey S (AUTHOR), Harrison DA (AUTHOR), Singer M (AUTHOR), Ashcroft J (AUTHOR), Jones CM (AUTHOR), Elbourne D (AUTHOR), Brampton W (AUTHOR), Williams D (AUTHOR), Young D (AUTHOR), Rowan K (AUTHOR), PAC-Man Study Collaboration (CORPORATE AUTHOR), Harvey, Sheila (AUTHOR), Harrison, David A (AUTHOR), Singer, Mervyn (AUTHOR), Ashcroft, Joanne (AUTHOR), Jones, Carys M (AUTHOR), Elbourne, Diana (AUTHOR), Brampton, William (AUTHOR), Williams, Dewi (AUTHOR), Young, Duncan (AUTHOR)
Source: Lancet. 8/6/2005, Vol. 366 Issue 9484, p472-477. 6p.
Abstract: Background: Over the past 30 years the pulmonary artery catheter (PAC) has become a widely used haemodynamic monitoring device in the management of critically ill patients, though doubts exist about its safety. Our aim was, therefore, to ascertain whether hospital mortality is reduced in critically ill patients when they are managed with a PAC.Methods: We did a randomised controlled trial to which we enrolled 1041 patients from 65 UK intensive care units. We assigned individuals to management with (n=519) or without (n=522) a PAC. The timing of insertion and subsequent clinical management were at the discretion of the treating clinician. Intensive care units decided a priori to have the option of using an alternative cardiac output-monitoring device in control patients.Findings: 1014 patients were eligible for analysis. We noted no difference in hospital mortality between patients managed with or without a PAC (68% [346 of 506] vs 66% [333 of 507], p=0.39; adjusted hazard ratio 1.09, 95% CI 0.94-1.27). We noted complications associated with insertion of a PAC in 46 of 486 individuals in whom the device was placed, none of which was fatal.Interpretation: Our findings indicate no clear evidence of benefit or harm by managing critically ill patients with a PAC. Efficacy studies are needed to ascertain whether management protocols involving PAC use can result in improved outcomes in specific groups if these devices are not to become a redundant technology. [ABSTRACT FROM AUTHOR]
Copyright of Lancet is the property of Lancet and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Psychology and Behavioral Sciences Collection
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  Data: Assessment of the clinical effectiveness of pulmonary artery catheters in management of patients in intensive care (PAC-Man): a randomised controlled trial.
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  Data: <searchLink fieldCode="AR" term="%22Harvey+S%22">Harvey S</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Harrison+DA%22">Harrison DA</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Singer+M%22">Singer M</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Ashcroft+J%22">Ashcroft J</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Jones+CM%22">Jones CM</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Elbourne+D%22">Elbourne D</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Brampton+W%22">Brampton W</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Williams+D%22">Williams D</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Young+D%22">Young D</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Rowan+K%22">Rowan K</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22PAC-Man+Study+Collaboration%22">PAC-Man Study Collaboration</searchLink> (CORPORATE AUTHOR)<br /><searchLink fieldCode="AR" term="%22Harvey%2C+Sheila%22">Harvey, Sheila</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Harrison%2C+David+A%22">Harrison, David A</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Singer%2C+Mervyn%22">Singer, Mervyn</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Ashcroft%2C+Joanne%22">Ashcroft, Joanne</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Jones%2C+Carys+M%22">Jones, Carys M</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Elbourne%2C+Diana%22">Elbourne, Diana</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Brampton%2C+William%22">Brampton, William</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Williams%2C+Dewi%22">Williams, Dewi</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Young%2C+Duncan%22">Young, Duncan</searchLink> (AUTHOR)
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  Data: <searchLink fieldCode="JN" term="%22Lancet%22">Lancet</searchLink>. 8/6/2005, Vol. 366 Issue 9484, p472-477. 6p.
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  Data: <bold>Background: </bold>Over the past 30 years the pulmonary artery catheter (PAC) has become a widely used haemodynamic monitoring device in the management of critically ill patients, though doubts exist about its safety. Our aim was, therefore, to ascertain whether hospital mortality is reduced in critically ill patients when they are managed with a PAC.<bold>Methods: </bold>We did a randomised controlled trial to which we enrolled 1041 patients from 65 UK intensive care units. We assigned individuals to management with (n=519) or without (n=522) a PAC. The timing of insertion and subsequent clinical management were at the discretion of the treating clinician. Intensive care units decided a priori to have the option of using an alternative cardiac output-monitoring device in control patients.<bold>Findings: </bold>1014 patients were eligible for analysis. We noted no difference in hospital mortality between patients managed with or without a PAC (68% [346 of 506] vs 66% [333 of 507], p=0.39; adjusted hazard ratio 1.09, 95% CI 0.94-1.27). We noted complications associated with insertion of a PAC in 46 of 486 individuals in whom the device was placed, none of which was fatal.<bold>Interpretation: </bold>Our findings indicate no clear evidence of benefit or harm by managing critically ill patients with a PAC. Efficacy studies are needed to ascertain whether management protocols involving PAC use can result in improved outcomes in specific groups if these devices are not to become a redundant technology. [ABSTRACT FROM AUTHOR]
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  Data: <i>Copyright of Lancet is the property of Lancet and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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