Sunday March 11, 2007
Pulmonary Artery Catheter (PAC) supplement

In recent years, use of PAC and it benefits has been questioned in many studies. Recent supplement on PAC (available free on net) at ccforum.com is a valuable read on this debate.

As Professor Jean-Louis Vincent wrote in its editorial:..."So, amidst all of these gloomy reports, does the PAC have a future or is it doomed to gather dust at the back of ICU equipment cupboards before reaching its final resting place as a curiosity in museums of medical history? I believe that the PAC still has a place in today's ICU, and that the information it provides can be integrated with that derived from newer equipment to optimize patient care. The PAC is a monitoring tool; if it is used to direct therapy and there is no improvement in outcome, then the therapy does not help. We know that PAC-derived data can prompt therapy to improve patient outcomes but such improvements are not always achieved (e.g. sometimes physicians do not make the necessary changes to their therapy as suggested by the measurements) or indeed there may be overzealous application of therapies (e.g. fluid challenge for low cardiac filling pressure when there is no need for it). Thus, there is a need for better strategies based on the measurements obtained."

Articles include topics like

• Hemodynamic optimization of sepsis-induced tissue hypoperfusion
• Clinical relevance of data from the pulmonary artery catheter
• Oxygen uptake-to-delivery relationship: a way to assess adequate flow
• What role does the right side of the heart play in circulation?
• Which cardiac surgical patients can benefit from placement of a pulmonary artery catheter?
• Which general intensive care unit patients can benefit from placement of the pulmonary artery catheter?
• Evidence-based review of the use of the pulmonary artery catheter: impact data and complications

Access full supplement here.

Monday March 5, 2007
ScVO2 and SVO2 - debate going on !!

There is an intensified debate about correlation between mixed venous (SVO2) and central venous oxygen saturation (ScVO2) since inclusion of ScVO2 as a marker in "River's early goal directed therapy" for sepsis. And publication of article: Lack of Equivalence Between Central and Mixed Venous Oxygen Saturation by Chawla and coll. in chest (2004)

We had previously posted pearl with references regarding this debate and recommended approach of its use. See our previous pearl ScvO2 or SvO2 ?

Another attempt to look into this issue has been published recently in Indian Journal of Critical Care Medicine. 298 comparative sets of samples from 60 adult patients were obtained, after a Pulmonary Artery Catheter and triple lumen catheter was inserted through right IJV. Mixed venous oxygen saturations and central venous oxygen saturations were compared.

The mean difference between Svo2 and Scvo2 was - 5.14

Study concluded that Scvo2 and Svo2 are closely related and are interchangeable.

Editor's note: One limitation of this study we noticed, is single type patient population with first 30 hours of post-operative period. Caution is advise before applying to all section of critically ill patients.


References: Click to get abstract/article

1. Lack of Equivalence Between Central and Mixed Venous Oxygen Saturation Chest. 2004;126:1891-18962. Correlation of mixed venous and central venous oxygen saturation and its relation to cardiac index, Indian Journal of Critical Care Medicine, Year 2006, Volume : 10, Issue : 4, Page : 230-234