TRIAL OF PULMONARY ARTERY CATHETER VS CENTRAL VENOUS CATHETER FOR ARDS

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This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. The pulmonary arterial catheter (PAC) was introduced for clinincal use in 1970 to provide diagnostic and monitoring information not available from other clinical sources. The PAC provides a wealth of direct and indirect information about circulatory, and respiratory systems and intravascular fluid volume over time. The PAC allows measurement of central venous and pulmonary arterial pressure, pulmonary artery occlusion pressure (PAOP or "wedge pressure"), mixed venous blood gases, and indicator-dilution cardiac output. This data is quantitative and since it is, more information, such as systemic and pulmonary vascular resistance can be derived. The accuracy of these measurements is high in well-trained and qualified hands, but is subject to proper placement of the catheter, calibration of transducers and user interpretation of waveforms and data. PAC data properly interpreted help to assess the right and left ventricle function, intracardiac shunts, pulmonary ventilatory function and intra-vascular fluid status. A pulmonary arterial catheter that is properly maintained allows for ongoing monitoring, which may provide early information regarding trends towards improvement or deterioration in response to therapeutic intervention. The PAC catheter is used commonly in patients with acute lung injury (ALI) and its most severe subset, the acute respiratory distress syndrome (ARDS). ALI is a clinical problem of significant magnitude in terms of incidence (150,000 patients per year), mortality (30-60% in most series) and cost (in part due to long stays in intensive care). In patients with ALI, the PAC has been employed widely both to confirm the diagnosis as well as to optimize hemodynamic management. Theoretically, measurement of the PAOP and cardiac output may make it possible for physicians to maintain pulmonary vascular pressures at a lower level, thus reducing the quantity of pulmonary edema that may develop in the presence of increases in lung vascular permeability. Also, maintaining a lower pulmonary capillary pressure may prevent or minimize damage ("stress failure") to the capillary wall. The measurement of pulmonary arterial pressure and cardiac output may make it possible for physicians to administer vasoactive agents more skillfully in order to optimize cardiac output, maintain or improve renal function, and increase systemic blood pressure and blood flow to vital organs. On the other hand, it is possible that the measurement of central venous pressure along with a central venous catheter (CVC) is adequate to optimize hemodynamics in patients with ALI.