Obituary : pulmonary artery catheter 1970 to 2013 Paul
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چکیده
The birth of the intermittent injectate-based conventional pulmonary artery catheter (fondly nicknamed PAC) was proudly announced in the New England Journal of Medicine in 1970 by his parents HJ Swan and William Ganz. PAC grew rapidly, reaching manhood in 1986 where, in the US, he was shown to influence the management of over 40% of all ICU patients. His reputation, however, was tarnished in 1996 when Connors and colleagues suggested that he harmed patients. This was followed by randomized controlled trials demonstrating he was of little use. Furthermore, reports surfaced suggesting that he was unreliable and inaccurate. It also became clear that he was poorly understood and misinterpreted. Pretty soon after that, a posse of rivals (bedside echocardiography, pulse contour technology) moved into the neighborhood and claimed they could assess cardiac output more easily, less invasively and no less reliably. To make matter worse, dynamic assessment of fluid responsiveness (pulse pressure variation, stroke volume variation and leg raising) made a mockery of his ‘wedge’ pressure. While a handful of die-hard followers continued to promote his mission, the last few years of his existence were spent as a castaway until his death in 2013. His cousin (the continuous cardiac output PAC) continues to eke a living mostly in cardiac surgery patients who need central access anyway. This paper reviews the rise and fall of the conventional PAC.
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Obituary: pulmonary artery catheter 1970 to 2013
The birth of the intermittent injectate-based conventional pulmonary artery catheter (fondly nicknamed PAC) was proudly announced in the New England Journal of Medicine in 1970 by his parents HJ Swan and William Ganz. PAC grew rapidly, reaching manhood in 1986 where, in the US, he was shown to influence the management of over 40% of all ICU patients. His reputation, however, was tarnished in 19...
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References: 1. Gidwani UK, Mohanty B, Chatterjee K: The pulmonary artery catheter: a critical reappraisal. Cardiol Clin 2013; 31: 545−65, viii. doi: 10.1016/j. ccl.2013.07.008. 2. Aggarwal N, Kupfer Y, Yoon TS, Tessler S: Pulmonary artery catheter coiled in the main pulmonary artery trunk. BMJ Case Rep 2013; 2013. doi: 10.1136/bcr-2013-200049. 3. Starzyk L, Yao E, Roche-Nagel G, Wasowicz M: Sna...
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The history of the pulmonary artery catheter spans almost 90 years from the first reported cardiac catheterization by Werner Forssmann (on himself!) in 1929. Some 25 years later, a balloon-tipped catheter was developed by Lategola and Rahn [1] and used in dogs, but the name of the catheter (and much of the credit for its invention) went to Swan and Ganz, whose now famous paper on the use of a b...
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The use of Swan-Ganz catheters has increased tremendously since they were first introduced in 1970. Their ability to give vital hemodynamic measurements in critically ill patients makes their use invaluable when providing quality medical care. The formation of pulmonary artery (PA) pseudoaneurysm from a Swan-Ganz catheter-induced perforation of the PA is a rare but potentially fatal complicatio...
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Citation: Stefanie Keymel and Stephan Steiner. “Swan-Ganz Pulmonary Artery Catheterization–Safe But Not Harmless”. EC Pulmonology and Respiratory Medicine 2.1 (2016): 52-56. Introduction Swan-Ganz catheter is widely used for the diagnosis of pulmonary hypertension as well as hemo-dynamic monitoring in intensive care medicine or perioperative management since its inauguration in 1970. Complicati...
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