THE PULMONARY-ARTERY CATHETER

The introduction of the pulmonary artery (PA) catheter in routine practice by Swan and Ganz at the beginning of the 1970s has enhanced our understanding of the mechanisms of patients' decompensation and has helped to guide appropriate therapeutic interventions in many diseases. Everybody who uses this monitoring instrument should become familiar with its technical concepts and theoretical basis. Modern technology has provided a large number of sophisticated developments, particularly in the past decade. Today we are able to obtain a huge mass of haemodynamic and oxymetric data in the critically ill. It is a common misconception in clinical practice that PA catheters should be employed for documentation of the haemodynamic catastrophe; however, it should be used to avoid significant haemodynamic problems. In recent years the value of PA catheter monitoring has been called into question. Whether a monitoring device can improve 'outcome' may be doubted. Although some opponents of haemodynamic monitoring wish to turn back the clock to the old days of a 'finger on the pulse', there is no doubt that the use of the PA catheter may yield additional information or that some of this information may be useful when the data are interpreted carefully. The time has come not only to criticize this monitoring instrument, but to examine future perspectives and visions.