tailieunhanh - Báo cáo y học: "Recently published papers: dying Swans and other stories"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care cung cấp cho các bạn kiến thức về ngành y đề tài: Recently published papers: dying Swans and other stories. | Available online http content 10 4 152 Commentary Recently published papers dying Swans and other stories Hannah Rose and Richard Venn Department of Critical Care Worthing General Hospital Worthing UK Corresponding author Richard Venn Published 28 July 2006 This article is online at http content 10 4 152 2006 BioMed Central Ltd Critical Care 2006 10 152 doi cc4990 Abstract The use of pulmonary artery catheters is under debate yet again. We look at two recent trials evaluating their impact on mortality. Our suspicions regarding obesity are proven and we also look at a simple cost effective method of reducing ventilator-associated pneumonia. Finally an intervention to improve the poor outcome associated with out-of hospital cardiac arrests is evaluated. A dying Swan FACTT or fiction The invention of the pulmonary artery catheter PAC 38 years ago by Drs Jeremy Swan and William Ganz was embraced by the medical world wholly and enthusiastically. It was presumed that the increased information provided would help deliver a more tailored and scientific approach to our critically unwell patients. However concerns regarding their usefulness and safety are increasingly evident 1 and with the development of alternative tools to calculate haemodynamic parameters the use of the PAC is dwindling. The latest study to question their use compares PAC to central venous catheter CVC guided therapy in the management of 1 000 patients with newly established acute lung injury in a multi-centre prospective randomised trial 2 . This Fluid and Catheter Treatment Trial FACTT assessed 60 day mortality fluid balance ventilator-free days intensive therapy unit ITU length of stay and complication rates. Catheter-derived haemodynamic parameters and clinical measures were used in conjunction with explicit protocols to guide fluid inotrope and diuretic management. Mortality rates were similar in both groups PAC and CVC as were the .