The pulmonary artery catheter: the tool versus treatments based on the tool

The pulmonary artery catheter (PAC) is a powerful tool that has been used extensively in the assessment and monitoring of cardiovascular physiology. Gross misinterpretation of data gathered by the PAC is common, and its routine use without any specific interventions has not been shown to influence outcome. However, there currently is no evidence from randomized, controlled trials that any diagnostic or monitoring tool used in intensive care patients improves outcome. Studies evaluating the use of the PAC have included numerous potential confounding factors, and should be interpreted with caution. The information obtained with the PAC should be used to find better treatment strategies, and these strategies, instead of the tool itself, should be tested in clinical trials

Metrics in the preparedness process

The phenomenon under study relates to the preparedness process. We need metrics to achieve multi-strategic goals. Situational factors and the direction of development of operational priorities are measurable factors. Public officers need measure these, that political decision-makers leads in the right direction. The research problem of a new servant in office is how to interpret the measured results to make a decision proposal. The research method was an action research. The problem solving follows the logical steps of the Deming Cycle: Plan the exercise, Do the notes, Study the content, Act customer-oriented. Multi-method approach promotes value-generating processes in the region’s hybrid organization. The evaluation of results is based on stakeholder feedback, a participate-decision by the City of Kotka’s Urban Board and a decision on funding by the Kymenlaakso Regional Council. In practice, content analysis of situational factors creates certainty of interpretation about the direction of development of operational priorities. This is important for BCFI analysis especially in turbulent situations. Implemented in the context of the readiness exercise, this was found to be exceptionally meritorious.© Acta Logistica, www.actalogistica.eu. This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.fi=vertaisarvioitu|en=peerReviewed

Pulmonary capillary pressures during the acute respiratory distress syndrome

Objectives: (1)To describe the evolution of pulmonary capillary pressure (Pcap) and of the pressure drop across the pulmonary venous bed from early to established acute respiratory distress syndrome (ARDS), (2) to assess Pcap under different levels of positive end-expiratory pressure (PEEP) and (3) to compare the visual method and a mathematical model to determine Pcap. Design: Prospective, intervention study. Setting: Intensive care unit in a teaching institution. Patients: Nine ARDS patients, according to the ARDS Consensus Conference criteria. Interventions: Pulmonary arterial pressures were measured during routine respiratory mechanics measurements throughout ARDS. Four PEEP levels (6, 9, 12 and 15cmH2O) were studied. Measurements and results: Pulmonary artery occlusions were made in triplicate at each PEEP level. Pcap was determined for every occlusion trace by three observers (visual method) and a mathematical model. Diastolic pulmonary artery pressure (PAPd) and pulmonary artery occlusion pressure (PAOP) were measured. The visually determined Pcap showed a bias of 2.5±2.1mmHg as compared to the mathematical estimation. PAPd, Pcap and PAOP tended to decrease from early to late ARDS (p=0.128, 0.265, 0.121). Pcap−PAOP (6.3±2.7mmHg) did not change throughout ARDS. Higher PEEP levels were associated with increased PAPd, Pcap and PAOP, as well as with larger Pcap−PAOP throughout ARDS. Conclusions: Pulmonary capillary pressure cannot be predicted from PAOP during early and established ARDS. The high variability in Pcap−PAOP increases the risk for underestimation of filtration pressures and consequently the risk for lung edema. Pcap can be estimated at the bedside by either the visual or mathematical method