CHEST Guidelines-Perioperative-Hemodynamic-Optimization-in-Cardiac-

Perioperative-Hemodynamic-Optimization-in-Cardiac-

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The use of routine perioperative pulmonary artery catheters (PAC) in cardiac surgery has been debated over the past two decades. While earlier large studies indicated negligible benefits or potential harm from PAC in low-risk patients, a 2024 joint consensus recommended against PAC usage in such populations due to increased healthcare costs without improved outcomes. Furthermore, research suggests PACs might not benefit high-risk patients either, as studies indicated higher in-hospital deaths, prolonged ventilation, and extended hospital stays in patients with PACs.<br /><br />In contrast, recent analyses such as a study by Ju et al., examining nearly 45,000 Korean patients, found lower 1-year and 30-day mortality rates in those who had PACs post-cardiac surgery, albeit with a slightly longer hospital stay. Interestingly, the study noted varied effects based on the institution's surgery volume and specific surgical subgroups, suggesting that PAC data might be more beneficial in low-volume centers or specific surgical procedures like off-pump coronary artery bypass grafts (CABG).<br /><br />Despite widespread use and acknowledged variability in practice concerning PACs, concerns remain due to mixed findings from previous studies and retrospective nature limitations. While some suggest PAC data is vital for perioperative management and early complication recognition, particularly in centers with less experience, there are calls for prospective trials to clarify PAC's real-value without selection bias influencing outcomes. Ultimately, while these findings do not apply outside cardiac surgeries or non-cardiac intensive care settings, they highlight the necessity for focused research on high-risk populations which could most benefit from detailed hemodynamic monitoring. <br /><br />The research underscores the ongoing debates surrounding PAC use, urging for cautious interpretation and adoption of its use until further, more conclusive data are available.

Keywords

perioperative pulmonary artery catheters

cardiac surgery

PAC usage

healthcare costs

patient outcomes

mortality rates

surgical subgroups

hemodynamic monitoring

prospective trials

high-risk populations