The new pulmonary artery catheters: continuous venous oximetry, right ventricular ejection fraction, and continuous cardiac output.

OBJECTIVE: To review the literature addressing the new pulmonary artery catheters: continuous venous oximetry, right ventricular ejection fraction, and continuous cardiac output. DATA SOURCE: All pertinent English language literature dealing with new pulmonary artery catheters were retrieved from 1981 through 1996. STUDY SELECTION: Articles were chosen for review if the primary objective of the paper was study or review of technology related to new pulmonary artery catheters. DATA EXTRACTION: From the literature selected, information was obtained about continuous venous oximetry, right ventricular ejection fraction, and continuous cardiac output catheters. DATA SYNTHESIS: When pulmonary artery catheterization is used, continuous venous oximetry catheters may be considered for use when it is anticipated that therapy will be based upon oxygen transport end points. When pulmonary artery catheterization is used, right ventricular ejection fraction catheters may be considered for use when the anticipated therapy will be based upon evaluation of ventricular preload and when central venous pressure and/or pulmonary artery occlusion do not accurately reflect preload. When pulmonary artery catheterization is used, continuous cardiac output catheters may be considered for use in titration of interventions employed to alter stroke volume.
CONCLUSION: Clinician misinterpretation and misapplication of the data appear to be the greatest impediment to using pulmonary artery catheterization to alter pathophysiologic processes and improve outcome in critically ill patients. Future research should first document effectiveness or lack of effectiveness of the "standard" pulmonary artery catheter (PAC). Pending these results, outcome and cost/benefit studies should be performed comparing "standard" with new PACs.