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The Efficacy of Central Venous and Pulmonary Artery Catheters and Therapy Based Upon Them in Reducing Mortality and Morbidity
William C. Shoemaker, MD;
Harry B. Kram, MD;
Paul L. Appel, MPA;
Arthur W. Fleming, MD
Arch Surg. 1990;125(10):1332-1338.
Abstract
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• The purpose of this study was to (1) evaluate the relative cost effectiveness of the central venous pressure and flow-directed pulmonary artery catheters used to maintain normal hemodynamic values as therapeutic goals in the control groups vs supranormal values empirically observed in critically ill postoperative survivors in the protocol groups, and (2) to evaluate tissue perfusion and oxygenation in relationship to organ failure and mortality. In two prospective clinical trials there were no significant differences in outcome between the central venous pressure and pulmonary artery control groups that used normal values as therapeutic goals. However, there were marked and significant reductions in morbidity and mortality of the protocol groups using the supranormal cardiac index, oxygen delivery, and oxygen consumption values as goals. The cumulative oxygen debt was less and organ failures were fewer and less severe in the protocol groups than in the control groups.
(Arch Surg. 1990;125:1332-1338)
Author Affiliations
From the Departments of Surgery, Charles R. Drew University of Medicine and Science, King/Drew Medical Center (Drs Shoemaker, Kram, and Fleming and Mr Appel); and the UCLA School of Medicine, Los Angeles, Calif (Drs Shoemaker and Fleming).
Footnotes
Accepted for publication July 12, 1990.
Read before the 61st Annual Meeting of the Pacific Coast Surgical Association, Laguna Niguel, Calif, February 20, 1989.
Reprint requests to King-Drew Medical Center, Department of Surgery, 12021S Wilmington Ave, Los Angeles, CA 90059 (Dr Fleming).
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