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Intervention Review

Pulmonary artery catheters for adult patients in intensive care

  1. Sheila Harvey1,*,
  2. Duncan Young2,
  3. William Brampton3,
  4. Andrew Cooper4,
  5. Gordon S Doig5,
  6. William Sibbald6,†,
  7. Kathy Rowan7

Editorial Group: Cochrane Anaesthesia Group

Published Online: 19 JUL 2006

Assessed as up-to-date: 15 MAY 2006

DOI: 10.1002/14651858.CD003408.pub2

How to Cite

Harvey S, Young D, Brampton W, Cooper A, Doig GS, Sibbald W, Rowan K. Pulmonary artery catheters for adult patients in intensive care. Cochrane Database of Systematic Reviews 2006, Issue 3. Art. No.: CD003408. DOI: 10.1002/14651858.CD003408.pub2.

Author Information

  1. 1

    London School of Hygiene & Tropical Medicine, Medical Statistics Unit, London, UK

  2. 2

    John Radcliffe Hospital, Adult Intensive Care Unit, Oxford, UK

  3. 3

    Aberdeen Royal Infirmary, Department of Anaesthetics, Aberdeen, Scotland, UK

  4. 4

    Sunnybrook Health Sciences Centre, Department of Critical Medicine, North York, Canada

  5. 5

    Northern Clinical School, University of Sydney, Intensive Care Unit, Royal North Shore Hospital, St. Leonards, NSW, Australia

  6. 6

    The Cochrane Anaesthesia Review Group, Copenhagen, Denmark

  7. 7

    Intensive Care National Audit Research Centre, London, UK

  1. Deceased

*Sheila Harvey, Medical Statistics Unit, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E7HT, UK.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 19 JUL 2006


This is not the most recent version of the article. View current version (28 FEB 2013)



  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要


Pulmonary artery catheterization was adopted about 30 years ago and widely disseminated without rigorous evaluation as to whether it benefited critically ill patients. The technique is used to measure cardiac output and pressures in the pulmonary circulation to guide diagnosis and treatment. Clinicians believe these data can improve patients' outcomes, even in the absence of consensus about the specific interpretation of the data.


To assess the effect of pulmonary artery catheterization on mortality and cost of care in adult intensive care patients.

Search methods

We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 2, 2006); MEDLINE (all records to April 2006); EMBASE (all records to April 2006); CINAHL (all records to April 2006) and reference lists of articles. We contacted manufacturers and researchers in the field.

Selection criteria

We included all randomized controlled trials in adults, comparing management with and without a pulmonary artery catheter (PAC).

Data collection and analysis

We screened the titles and abstracts of the electronic search results and obtained the full text of studies of possible relevance for independent review. We determined the final results of the literature search by consensus between the authors. We did not contact study authors for additional information.

Main results

We identified 12 studies. Mortality was reported as hospital, 28-day, 30-day, or intensive care unit. We considered studies of high-risk surgery patients (eight studies) and general intensive care patients (four studies) separately for the meta-analysis. The pooled odds ratio for the studies of general intensive care patients was 1.05 (95% confidence interval (CI) 0.87 to 1.26) and for the studies of high-risk surgery patients 0.99 (95% CI 0.73 to 1.24). Of the eight studies of high-risk surgery patients, five evaluated the effectiveness of pre-operative optimization but there was no difference in mortality when these studies were examined separately. Pulmonary artery catheterization did not affect intensive care unit (reported by 10 studies) or hospital (reported by nine studies) length of stay. Four studies, conducted in the United States, measured costs based on hospital charges billed to patients, which on average were higher in the PAC groups.

Authors' conclusions

To date, there have been two multi-centre trials of the effectiveness of PACs for managing critically ill patients admitted to intensive care, although only one was adequately powered. Efficacy studies are needed to determine optimal management protocols and patient groups who could benefit from management with a PAC.


Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Pulmonary artery catheters for adult patients in intensive care

The pulmonary artery catheter is a device used to measure blood flow and pressures in the heart and lung blood vessels. These measurements are used to guide treatment of critically ill patients or patients undergoing major surgery. Pulmonary artery catheters were first used in intensive care units about 30 years ago, but there is no clear evidence that using them to guide treatment actually allows patients to recover faster, or for more of them to survive their illness.

Twelve trials were identified comparing patients treated with and without the use of a pulmonary artery catheter. These were divided into trials of patients undergoing routine major surgery and trials of patients who were critically ill and admitted to intensive care for more wide-ranging reasons. There were eight trials in the major surgery group and only one was a large trial with nearly 2000 patients. The other trials were conducted in single hospitals and had no more than 120 patients taking part. There were four trials of critically ill patients, and two were large trials: one with nearly 700 patients and one with over 1000 patients. Overall, even though the trials measured numbers of deaths in each group at different points in time, all reported that there were no differences between patients who did and did not have a pulmonary artery catheter inserted. Five trials also measured the costs associated with using a pulmonary artery catheter. Four trials were conducted in the US and showed that on average the charges were higher for patients who had a pulmonary artery catheter. A study in the UK used a different approach to analyse costs of care and concluded that withdrawing the use of the pulmonary artery catheter might result in a cost saving.

Most of the trials identified were small, conducted in a single hospital with less than 200 patients taking part. Most were of patients undergoing routine major surgery. Neither group of patients studied showed any evidence of benefit or harm from a pulmonary artery catheter.



  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要







搜尋Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 2, 2006); MEDLINE (all records to April 2006); EMBASE (all records to April 2006); CINAHL (all records to April 2006)和文章的參考文獻。連繫該領域的廠商和研究人員。


我們納入所有成人的randomized controlled trials,較有無使用肺動脈導管之治療。


我們在電子搜索結果中審查標題和摘要,並取得了可能相關的獨立評論研究(independent review)的全文。我們以作者之間的共識來確定文獻檢索的最後結果。我們沒有為了其他資訊和研究作者接觸。


我們發現了12個研究。根據醫院、28天、30天、或加護病房來報告死亡率。我們認為高風險手術病人(8個研究)和一般加護病人(4個研究)的研究應分別做統合分析(metaanalysis)。一般加護病人研究匯集的odds ratio為1.05 (95% confidence interval (CI) 0.87 to 1.26),高風險手術病人研究的odds ratio則為0.99 (95% CI 0.73 to 1.24)。8個高風險手術病人的研究中,5個評估手術前最佳化(preoperative optimization)的成效,但這些研究被分開檢驗時,在死亡率上並沒有差異。肺動脈導管不影響住在加護病房的天數(十個研究報告)或住院的天數(九個研究報告)。 四個在美國進行的研究,以醫院給病人的收費帳單計算成本,在使用肺動脈導管這組平均較高。


迄今為止,有兩個multicentre trials研究肺動脈導管在加護病房重症病患身上的成效,雖然只有一個具有充分檢定力(power)。仍需要有效力的研究以確定最佳的處理程序,及可受益於肺動脈導管的病人群。



此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。


這個評論(review)試圖去決定使用肺動脈導管指引重症病患之治療是否減少他們的 死亡率或照護費用。肺動脈導管是一種測量心臟和肺臟血管血流和壓力的裝置。這些測量是用來引導治療重症病患或接受重大手術的病患。約30年前肺動脈導管首次使用於加護病房,但沒有明確的證據顯示利用他們來引導治療確實讓病患恢復快、或從疾病中悻存。12個比較有和沒有使用肺動脈導管的試驗(trials)被發現。這些試驗被劃分為進行例行大手術的病患和因為更廣泛原因住進加護病房之重症病患。有八個試驗是重大手術組,而且只有一個是近2000例的大型試驗。其他試驗是在單一醫院進行,並且不超過120名病患參加。有四個試驗為重症患者,其中兩個是大型試驗:一個近700名病患和1個超過1000例。整體而言,即使在不同時間點衡量各組的死亡數,所有試驗都報告在有或沒有使用肺動脈導管的病患之間,並沒有差別。五個試驗也測量了使用肺動脈導管相關的費用。四個在美國進行的試驗顯示使用肺動脈導管的病患平均收費較高。一項在英國的研究,用了不同的方法來分析照護的費用,得出撤回肺動脈導管的使用可能節省成本的結論。大部分發現的是小型試驗,在單一的醫院進行,小於200個病患參加。大部分是進行例行重大手術的病患。兩組病患的研究都沒顯示,任何因肺動脈導管而受益或損害的證據。