The cult of the Swan-Ganz catheter. Overuse and abuse of pulmonary flow catheters.

The use of pulmonary artery flow-directed catheters has assumed epidemic proportions without clinical trials establishing improved outcome as a result of their use. During the past 10 years, however, it has become clear that improved outcome is found only in small groups of patients and that use of these catheters is associated with considerable risks of morbidity and mortality. A clinical trial is urgently needed to assess the balance between risks and benefits. While awaiting such trials, physicians should limit catheter use to circumstances in which there is a large probability that the data will result in more effective management; the measurements should only be used to answer specific questions about patient therapy. This situation will occur in a relatively small number of patients.