Paul Jodka

The pulmonary artery catheter in critical care.

Pulmonary artery catheterization has been a routine part of care for critically ill patients over the past 25 years. Primary hemodynamic data regarding cardiac output and pulmonary pressures can be utilized to make diagnoses and guide therapy. Tissue oxygen delivery and utilization allow inferences about the efficiency of the cardiopulmonary system and the impact of disease and medical therapies on tissue metabolism. Goals of high level invasive monitoring of cardiopulmonary function with pulmonary artery catheterization are organ salvage and minimizing complications associated with critical illness. Optimizing renal perfusion and minimizing pulmonary congestion with precise volume titration are common reasons for performing pulmonary artery catheterization in the intensive care unit. Despite being reassuring to clinicians that hemodynamic therapy is optimal, multiple data from well conducted clinical studies have not demonstrated outcome benefits to patients related to pulmonary artery catheterization. Less invasive techniques to obtain data regarding hemodynamic function are now entering the clinical arena and are being actively investigated.

CRITICAL CARE ISSUES FOR THE NEPHROLOGIST: The Pulmonary Artery Catheter in Critical Care

Pulmonary artery catheterization has been a routine part of care for critically ill patients over the past 25 years. Primary hemodynamic data regarding cardiac output and pulmonary pressures can be utilized to make diagnoses and guide therapy. Tissue oxygen delivery and utilization allow inferences about the efficiency of the cardiopulmonary system and the impact of disease and medical therapies on tissue metabolism. Goals of high level invasive monitoring of cardiopulmonary function with pulmonary artery catheterization are organ salvage and minimizing complications associated with critical illness. Optimizing renal perfusion and minimizing pulmonary congestion with precise volume titration are common reasons for performing pulmonary artery catheterization in the intensive care unit. Despite being reassuring to clinicians that hemodynamic therapy is optimal, multiple data from well conducted clinical studies have not demonstrated outcome benefits to patients related to pulmonary artery catheterization. Less invasive techniques to obtain data regarding hemodynamic function are now entering the clinical arena and are being actively investigated.

CRITICAL CARE ISSUES FOR THE NEPHROLOGIST: The Pulmonary Artery Catheter in Critical Care: PULMONARY ARTERY CATHETERIZATION

Pulmonary artery catheterization has been a routine part of care for critically ill patients over the past 25 years. Primary hemodynamic data regarding cardiac output and pulmonary pressures can be utilized to make diagnoses and guide therapy. Tissue oxygen delivery and utilization allow inferences about the efficiency of the cardiopulmonary system and the impact of disease and medical therapies on tissue metabolism. Goals of high level invasive monitoring of cardiopulmonary function with pulmonary artery catheterization are organ salvage and minimizing complications associated with critical illness. Optimizing renal perfusion and minimizing pulmonary congestion with precise volume titration are common reasons for performing pulmonary artery catheterization in the intensive care unit. Despite being reassuring to clinicians that hemodynamic therapy is optimal, multiple data from well conducted clinical studies have not demonstrated outcome benefits to patients related to pulmonary artery catheterization. Less invasive techniques to obtain data regarding hemodynamic function are now entering the clinical arena and are being actively investigated.

Management of the septic patient in the operating room.

Sepsis, severe sepsis, and septic shock represent the spectrum of physiological response to a variety of infecting pathogens. Multiple-organ dysfunction may result from widespread activation of inflammatory and antiinflammatory mechanisms. Intensive multiorgan support, effective antibiotic therapy, and eradication of the inciting source remain the cornerstones in the care of septic patients. Perioperative planning and management need to ensure the continuation of such care in addition to providing for the requirements of the given surgical procedure.