%0 Journal Article
%T Recently published papers: all the usual suspects and carbon dioxide
%A Jonathan Ball
%J Critical Care
%D 2003
%I BioMed Central
%R 10.1186/cc2449
%X Since 1996, when Connors and colleagues published data suggesting right heart catheterisation in critically ill patients was associated with an increase in mortality [1], there has been a heated debate about the dangers and benefits of this monitoring intervention. December saw the publication of two further large-scale, multicentre trials into the use of pulmonary artery catheters.An American group published data from 1010 intensive care unit admissions with severe sepsis and performed a complex series of analyses having case-matched a subset from their prospective cohort [2]. They did not detect any significant differences in either inhospital mortality, length of stay or cost between patients who had or who had not had a pulmonary artery catheter.In the second, French, study, 676 patients with either shock, acute respiratory distress syndrome (ARDS) or both, were randomised to receive or not a pulmonary artery catheter [3]. Again, no difference in morbidity or mortality (up to 90 days) was found. Although fault can be found with the design of both of these trials, there can surely be no doubt remaining regarding the safety of inserting a piece of sterile plastic into the pulmonary artery. There remains, however, a lack of evidence that the monitoring provided by pulmonary artery catheters, or indeed other cardiac output monitoring devices, results in improvements in outcome. Arguably this reflects the controversies regarding optimal cardiovascular management rather than any intrinsic problem with flow monitoring.The ARDSnet group continue in their quest to direct the optimal ventilatory management of ARDS patients with the publication of their trial into the safety and efficacy of a daily recruitment manoeuvre [4]. They used a subset of low versus high positive end-expiratory pressure trial patients, taking all subjects from those randomised to the high positive end-expiratory pressure group. For their manoeuvre they chose a 30 s sustained inflation to 35¨C40 cmH2
%U http://ccforum.com/content/8/1/6