pa+cath+in+sepsis+a+lit+review.pdf - Elmer Review ress J Clin Med Res 2016;8(11:769-776 The Use of Pulmonary Artery Catheter in Sepsis Patients A

pa+cath+in+sepsis+a+lit+review.pdf - Elmer Review ress J...

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Articles © The authors | Journal compilation © J Clin Med Res and Elmer Press Inc™ | This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited 769 Review J Clin Med Res. 2016;8(11):769-776 ress Elmer The Use of Pulmonary Artery Catheter in Sepsis Patients: A Literature Review Dimitrios Velissaris a , Vasilios Karamouzos a , Ioanna Kotroni b , Charalampos Pierrakos c , Menelaos Karanikolas d, e Abstract This article was to review the literature regarding the use of the pul- monary artery catheter (PAC) in the management of patients with sepsis and septic shock. A PubMed search was conducted in order to identify publications evaluating the use of PAC as a tool for man- agement and therapeutic guidance in patients with sepsis. The bibli- ographies of all identified publications were reviewed for additional relevant references. Much information is identified in the literature regarding the indications for pulmonary artery catheterization in the assessment and treatment of patients with sepsis. Although the PAC has been widely used for many years, there is no clear benefit with regard to outcome, and there is controversy regarding its use. It is not clear that use of the PAC contributes to reduced morbidity and mortal- ity in patients with sepsis. The role of the PAC is becoming less clear, as newer, non-invasive techniques are developed for hemodynamic assessment of sepsis patients. Large, well-designed clinical trials are needed to better assess the role and potential benefit from use of the PAC in sepsis. Keywords: Sepsis; Monitoring; Pulmonary artery; Catheter; Inten- sive care; Critical care; Morbidity; Mortality; Circulation Introduction Several studies assessing the adverse effects of sepsis on the heart have shown that myocardial dysfunction is a common, severe complication of sepsis, and the mechanisms responsi- ble for development of myocardial dysfunction are complex. Hemodynamic monitoring is important in the management of critically ill sepsis patients, because it can help assess hemo- dynamic variables, identify causes of hemodynamic instabil- ity and monitor response to therapy. However, the benefit of hemodynamic monitoring in the management of sepsis and septic shock remains unproven. The pulmonary artery cath- eter (PAC) is an invasive device used largely in the intensive care unit (ICU) for monitoring, assessment and management of hemodynamic variables in critically ill patients, including patients with sepsis. PAC use varies between different ICUs and is influenced by several factors, including ICU organiza - tion, physician preference, patient insurance, race and clinical characteristics [1], but overall the use of the PAC in critical care is declining. The indication for PAC use is matter of de- bate because, despite earlier promising results, several well-
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