%0 Journal Article
%T Perioperative optimization and right heart catheterization: what technique in which patient?
%A Daniel De Backer
%A Jacques Creteur
%A Jean-Louis Vincent
%J Critical Care
%D 2003
%I BioMed Central
%R 10.1186/cc2177
%X More than 20 years ago, Shoemaker and coworkers [1,2] observed that perioperative alterations in oxygen transport were closely related to the development of organ failure and death. Subsequently, several studies reported that perioperative hemodynamic optimization guided by the pulmonary artery catheter may decrease morbidity and mortality [3-6]. Nevertheless, the use of the pulmonary artery catheter has been challenged because of its invasiveness and possibly the unwarranted interventions that may result from its use [7].In a recent issue of the New England Journal of Medicine, Sandham and coworkers [8] reported the results of a multicenter Canadian study that investigated the effects of right heart catheterization on perioperative complications in high-risk patients undergoing noncardiac surgery. From 1990 to 1999, those authors randomly allocated 1994 American Society of Anesthesiologists class III and IV patients to conventional monitoring and therapy or to right heart catheterization and hemodynamic optimization. They observed that survival (up to 1 year of follow up) and hospital stay did not differ between the two groups. The incidence of perioperative complications was similar in both groups, except for an increased incidence of pulmonary embolism in the pulmonary artery catheter group.Although Sandham and coworkers [8] must be commended for their important undertaking, the study raises a number of important concerns. First, although the authors claimed that no patient selection was performed, the inclusion rate of a mean of only 22 patients/center per year was surprisingly low. For example, close to 1000 patients with American Society of Anesthesiologists class III and IV are operated on each year in our 760-bed institution. One of the inclusion criteria was the commitment of the surgeon and the anesthesiologist to adhere to the study concept; the most severely ill patients might therefore have been excluded, and this may explain the unexpectedly low mortal
%K methodology
%K outcome
%K pulmonary artery catheter
%K SvO2
%U http://ccforum.com/content/7/3/201