SPECIAL ARTICLE
Ant%hrsiol(w 2W. W:%- to14
Practice Guidelinesfor Pulmonary A H e r y Catheterization
An Updated Report by tbe American Society of Anesthesiologists Task Force on
Pulmonary Artery Catheten'zatiolz
PRACTICE guidelines are systematically deveIoped rec-
omendations that assist the practitioner and patient in
making decisions about health care. These recommen-
dations may be adopted, modified, or rejected according
ta cIinica1 needs and constrains. Practice guidelines are
not intended as standards or absolute requirements. The
use of practice guidelines cannot guarantee any specific
outcome. Practice guidehnes are subject to revision as
warranted by the evolution of medical knowledge, tech-
nology, and practice. The guidelines provide basic recom-
mendations that am supported by analysis of the current
literature and by a synthesis of expert opinion, openfotum
commentary, and clinical feasibility data. The recommen-
dations, although derived in part from evidence obtained in
other countries,are intended for ptactitioners in the United
States; elements of the recommendatiom~and the princi-
ples on which they are based may also apply to practice
settings in other countries.
The balloon-flotation pulmonary artery (PA) catheter
was introduced in 1370.' PA catheter monitoring has
expanded rapidly and broadly in clinical practice since
the late 1970s. As of 1996, an estimated 2 million cath-
eters were sold annually oddw wide,^ with an estima~ed
2 billion dollars spent in the United States alone."."
The appropriate indications for PA catheter monitor-
ing have been debated for many years. The potential
benefits of using the device are well known. Its use in
t
This article is accompanied by an Editaria1 View. Please m:
Arens J: On behalf of the American Society of Anesthesinlo-
gists committee on practice parameters. ANEsWE\:claI.uciY 2003:
$9775-6.
Developed by the American Snctety of Anesthesiologistr Tark Force on Guide-
linlrs for Pulmonary Artery Catheterization: M~chaeIF. Rolzen, M.D. (Chair).
Ikpanmenr of Anecthesiolr>w.SUNY Upstatc. S y a c i ~ x Ncw . York, and Drpan-
men€ of Anesthesia and Cnrrcal Care, University of Chicago. Chrca~o,IlI~nolf.
David 1, RcrI:cr, M.D (Pnvate kactlct.). Pledn~tmt.~ l l f ~ r nR~oad:d k (iahel.
M.11..Depannlent of Anestllcsiolrm. IJniwnity of Rr>chc%tcr.Rochcst~-r.Ncw
Yurk: John Ccrson. M.11. (Pdvatc Practice). Syracuse. New York, Jonathan R.
Mark. M.D.. Dcpartml-nt of hnesthesiolopy. Duke Umversity Medical Center.
Durham, N o h C3rolina; Rohrn I. Parks. Jr., A1.D. ffrivatc Pmcti~r).Dallw
TLX~Y;David A hulus. M.I3., Depanmcnt of Anrsthrs~r>lngy,Un~vcrsivof
Florida, GmnesvilIc, I:lurida: Juhn S. Srntth, M.D (Private Prxctice), h s V e p q .
N e m d a ; and Sreven H. Worjlf. M.U..M.P.H. M e t h u d o l o ~Consultant). Depan-
ment of Rrnily Practice, Virginia c.mmonwealrh Ilnivrsity. Fairfax. Virf:tnra.
Submincrl for puhlicatiun Ntlvrmber 211. 2002. hrmprcx! for puhl~car~on Nnvem-
ber 20. Z M I Z .
Address rrprep requests to the American Sociery of A n ~ s t h c ~ i o t o ~520
m shop convened by the Food and Drug Administration
North Norrhwest Highway. R r k Ridge, lll~noishon(IK2573. Individual Practicc
Guideline may hc obraind at nu cost thruu~hthc Joumat Web sinr.
www.nnesthes~olngyor^
D 20113 Arnckm k c k t y nf Ancsth&t>loljsrs. Inc. Ijppinc~mWilliam%& Wlkinc. Inc.
measuring imponant hernodynamic indices (e.g., FA oc-
cfusion pre~,cute,cardiac output, mixed venous oxygen
saturation) allows more accurate determination of the
hernodynamic status of critically ill patients than is po+
sible by clinical assessment alone. The additional infor-
mation can be important in caring for patients with
confusing clinicaI pictures, in whom errors in fluid man-
agement and drug therapy can hare important conse-
quences. In surgical patients, PA catheter data often help
evaluate hernodynamic changes that may lead to serious
perioperative complications. Preoperative PA catheter
data are purported to be helpfuI in determining whether
it is safe for high-risk patients to proceed with surgery.
PA catheterization can also have important adverse
effects. Catheter insertion can resuIt in atterial injury,
pneumothorax, and arrhythmias. The catheter can he
associated with potentiaIly fatal PA hemorrhage, throrn-
boernbolism, sepsis, and endocardial damage.
The American Society of AnesthesioIogists established
the Task Force on Pulmonary Artery Catheterization in
1991 to examine the evidence for benefits and risks from
PA catheter use in settings encountered by anesthesiol-
ogists, By the rime the Society's guidelines were adopted
in 1992 and published in 1 9 9 3 , ~several p u p s had
issued statements on the appropriate indications for PA
catheterization and on competency requirements for he-
modynamic moni:toring. Rlese groups included the
American College of Physicians/American College of Car-
diolegy/herican Heart Association Task Force on CIin-
ical Privileges in ~ardiology,ba panel estabiished by the
Ontario Ministry of ~ealth,'and an expert panel of the
European Society of Intensive Care ~edicine.'
In subsequent years, a variety of studies, most notably
an Investigation by Connors et wl.," raised douhts about
the effectiveness and safety of pulmonary artery cathe-
terization (PAC). This literature, and the controversy it
stimulated, gave rise to additional policy statements from
the American College of Chest Physicians (Northbrook,
Illinois), American Thoracic Society (New York, New
York), and the American ColIege of Cardiology (Re-
thesda, ~ a r ~ l a n d ) 'and
' from such convocations as a
consensus conference convened by the Society of Criti-
cal Care Medicine (DesPlaines, ~llinois)" (subsequently
endorsed by multiple organizations) and a 1998 work-
@ockvilIe, Maryland) and the National Institutes of
HeaIth methesda, Maryland)." F ~ e wof these efforts fo-