Swan-Ganz catheter can help patients--but which ones?

BMJ 1995; 311 doi: https://doi.org/10.1136/bmj.311.7005.627a (Published 02 September 1995) Cite this as: BMJ 1995;311:627
  1. Adrian P H Steele, Registrar in anaesthesia St Peter's Hospital, Chertsey
  1. Surrey KT16 0PZ

    EDITOR,--J Goodwin is right to emphasise the importance of clinical skills in medical practice, but I dispute the suggestion that use of the Swan-Ganz catheter to measure intracardiac pressures is “a good example of the clinically inexperienced being dependent on high technology.”1 Several studies have shown the inaccuracy of the results of clinical assessment compared with the information derived from a pulmonary artery catheter.2 3 In a mixed population of patients receiving intensive care Steingrub et al compared physicians' estimates of pulmonary artery wedge pressure with the measured values.4 In 53% of cases the physician was unable to predict correctly whether the pressure was low (<10 mm Hg), medium (10-18 mm Hg), or high (>18 mm Hg). There seems to be little doubt that in critically ill patients the Swan-Ganz catheter provides information that is not available from simple clinical observation. The only remaining uncertainty concerns the selection of patients for whom the benefit of this information exceeds the not insignificant complications of insertion of the catheter.4


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