Catéter de Swan Ganz: Opinión de expertos

Actualmente existen dudas sobre la seguridad del uso del catéter de Swan Ganz (CSG). Para definir la opinión de los cardiólogos de nuestro país, el Consejo de Emergencias Cardiovasculares de la Sociedad Argentina de Cardiología (SAC) realizó una reunión para evaluar la opinión de expertos en diferentes escenarios (cirugía no cardíaca, cardíaca, síndromes coronarios e insuficiencia cardíaca), usando el método RAND-UCLA appropiateness. Se envió la evidencia bibliográfica previa a la reunión en la SAC y en la misma los panelistas seleccionaron las variables para conformar las situaciones clínicas que luego fueron enviadas para que individualmente, en una segunda etapa, determinaran si consideraban beneficioso o perjudicial la utilización del catéter con una escala de 1 a 9 (1 significaba que los potenciales perjuicios superaban a los beneficios, 9 que los beneficios eran mayores y 5 que podía considerarse indistintamente beneficioso o perjudicial). Dos expertos analizaron los resultados, describiendo la tasa de acuerdo/desacuerdo. Finalmente, cada indicación se clasificó como “apropiada”, “dudosa” o inapropiada de acuerdo a la mediana definida por los panelistas: 1-3 se clasificó como inapropiado, 4-6 dudoso y 7-9 como indicación apropiada. Observamos gran discrepancia en la opinión sobre la indicación de CSG entre los expertos. Sin embargo, los panelistas estuvieron a favor de su utilización en situaciones que incluían shock y disfunción miocárdica, especialmente cuando se asoció disfunción orgánica. Hubo situaciones en las que los panelistas consideraron inapropiada la indicación del CSG, en pacientes sin disfunción orgánica.

Investigators have raised doubts as to the safety of the Swan Ganz catheter (SGC). In order to define the point of view of cardiologists in our country, the Argentine Society of Cardiology’s Emergency Council organized a meeting to analyze their views in different settings (non-cardiac surgery, cardiac surgery, acute coronary syndromes and heart failure) using the RAND-UCLA appropriateness method. A detailed review with the scientific evidence was sent to the experts in cardiology prior to the meeting in the SAC auditorium where the panellists selected the clinical variables create the specific situations. These hypothetic situations were resent to the panellists at a second stage for their individual evaluation, rating the benefit-to-harm ratio of the procedure on a scale of 1 to 9 (1 meant that the expected harms greatly outweighed the expected benefits, and 9 that the expected benefits greatly outweighed the expected harms, 5 could mean either that the harms and benefits were roughly equal). Two experts analyzed the results, describing the agreement/disagreement ratio. Finally, each indication was classified as “appropriate,” “uncertain” or “inappropriate” for the procedure in accordance with the panelists’ median score: median scores in the 1-3 range were classified as inappropriate, those in the 4-6 range as uncertain, and those in the 7-9 range as appropriate. We observed high disagreement rates in SGC indications between cardiologists. However, the panelists were in favor of SGC use when situations included shock and myocardial dysfunction, especially in the presence of organic dysfunction. There were some situations when panelists considered SGC not useful, in patients without organ failure.

Do we need a pulmonary artery catheter in cardiac anesthesia? - An Indian perspective.

There has been considerable controversy regarding the use of pulmonary artery catheter (PAC) in clinical practice. Some studies have indicated poor outcome in patients who were monitored with PAC. However, these studies, which have condemned the use of PAC, were conducted on patients in intensive care units, where the clinical scenarios with regard to patients' status are somewhat different as compared to those of a cardiac operating room. This study was designed to identify the indications of PAC use in cardiac operating rooms. A questionnaire was mailed to anasthesiologists in cardiac centers and the response was analyzed.The practicing cardiac anesthesiologists recommended the use of PAC for following indications in cardiac surgery: coronary artery bypass grafting (CABG) with poor left ventricular (LV) function, LV aneurysmectomy, recent myocardial infarction (MI), pulmonary hypertension, diastolic dysfunction, acute ventricular septal rupture and insertion of left ventricular assist device (LVAD).The analysis of responses from practicing anesthesiologists clearly indicates that use of a PAC cannot be recommended as a matter of routine, but a definite role is suggested in selected groups of patients undergoing cardiac surgery.

Retrospective review of the use of Swan Ganz Catheters in our intensive care unit [ICU]: a short report

The widespread and often 'misuse' of the Swan Ganz [SG] or Pulmonary artery catheter has often been seen in intensive care patients. The objective of this preliminary review was to observe the trends and possibly formulate an association with outcome of the use of SG catheters as well as to determine the frequency of use and possible complications.The chart review of ten patients was carried out for the months of January and February 2004 in a retrospective manner. The incidence of SG catheter insertion was 12% per month on average. Nine out of 10 patients received the SG catheters for 'fluid management'; and 1 for 'haemodynamic instability'. Eight out of 10 patients expired and average length of stay was 9 days. There were no complications recorded. The cause of death in all patients was 'severe sepsis'. The overwhelming majority of patients who received these catheters expired at the end of their stay

Pulmonary artery catheter complications: report on a case of a knot accident and literature review

É relatada uma complicação infreqüente , associada ao uso do Cateter de Artéria Pulmonar. Uma paciente de 41 anos foi admitida no Pronto Socorro do nosso hospital com hemorragia digestiva alta grave. A doente foi submetida à gastrectomia total. Na Unidade de Terapia Intensiva, evoluiu com instabilidade hemodinâmica, sendo indicada a monitorização hemodinâmica invasiva com cateter de artéria pulmonar. Durante as manobras para o correto posicionamento do cateter na artéria pulmonar, foi diagnosticado formação de nó verdadeiro, ao nível da veia cava superior. Os autores discutem as várias opções técnicas empregadas para a resolução desta complicação, através do emprego da radiologia intervencionista endovascular. Extensa revisão da literatura procurando discutir os benefícios e riscos envolvidos na monitorização hemodinâmica invasiva com o cateter de artéria pulmonar, no período peroperatório, foi realizada. Assim como as orientações práticas emitidas pela Conferência de Consenso sobre o cateter de artéria pulmonar, realizada nos EUA em 1996, são discutidas com profundidade.

Manejo del catéter de Swan-Ganz / Management of the Swan-Ganz catheter

El uso del catéter Swan-Ganz, cada vez más frecuente en el área pediátrica, ha motivado la realización de este trabajo donde se realizarán aspectos generales del catéter y cuidados de enfermería en el monitoreo de arteria pulmonar y medición de gasto cardíaco

El catéter de Swan-Ganz / Swan-Ganz catheter

Si debemos monitorizar en forma invasora al paciente gravemente enfermo es importante tener en cuenta como primera medida al sistema cardivascular. Existen varias razones por ello: el paciente gravemente enfermo por lo general experimenta un compromiso en la función de su sistema cardivascular, en forma variable; las alteraciones cardiorespiratorias y el transporte del oxígeno determinan, junto con el estado del sistema nerviosos central, el pronóstico a corto plazo del invididuo; las alteraciones cardiovasculares son frecuentemente súbitas y pueden acarrear consecuencias funestas si no se reconocenen forma precoz; las alteraciones del sistema cardivascular no son predecibles en forma fiable y temprena basados en el método clínico tradicional (observación, palpación, percusión y auscultación).

Complicación rara del catéter de Swam Ganz en cirugía cardíaca / Complication of Swan-Ganaz catheter in heart surgery

Reportamos tres casos, en los cuales el catéter de Swan-Ganz (S-G), fue accidentalmente fijado a la pared de la aurícula derecha (A.D.), durante el acto operatorio. El accidente sólo se evidencia en el momento de retirarlo. Los tres casos fueron reintervenidos quirúrgicamente. Se describe la técnica operatoria y los métodos diagnósticos. Revisamos la literatura respectiva y enfatizamos la importancia de esta complicación así como la metodología para evitarla

Cateterismo cardíaco à beira do leito: vantagens e desvantagens / Bedside cardiac catheterization: advantages and disadvantages

Foram estudados 300 pacientes submetidos a cateterismo cardíaco direito à beira do leito (CCDBL) pela técnica de Swan-Ganz, visando avaliar a relaçäo das medidas obtidas com a classificaçäo de Killip-Kimball, e determinar a prevalência de complicaçöes. Dos 300 casos, 267 (89%) eram portadores de infarto agudo do miocárdio (IAM), estando 146 em classe II, 36 em classe III e 71 em classe IV. A introduçäo do cateter obteve êxito em 288 casos (96%), conseguindo-se obter a medida da pressäo encravada na artéria pulmonar (PEAP) em 236 (78,7%) doentes. Nos casos de IAM, a medida da PEAP estava abaixo de 18 mmHg em 47,2% dos pacientes em classe II, em 44,1% daqueles em classe III e em 35,3% dos casos em classe IV. Intercorrências ocorreram em 33 pacientes (11%): ruptura do balonete em 12 (4%), arritmias transitórias em 11 (3,7%) e obstruçäo do cateter em 10 (3,3%). Houve complicaçöes em 45 casos (14,7%): infarto pulmonar em 18 (6%), flebite em 15 (5%), arritmia persistente em 10 (3,3%), ruptura da artéria pulmonar e endocardite infecciosa em um caso cada. As médias de idade foram semelhantes nos grupos com e esem complicaçöes, mas o tempo de permanência do cateter foi significativamente maior no grupo com complicaçöes: 3,4 ñ 0,2 vs 2,7 ñ 0,1 dias (p < 0,05). Concluímos que percentagem apreciável de pacientes clinicamente em classes II, III e IV apresentavam PEAP abaixo de 18 mmHg. O tempo de permanência do cateter constituiu-se num importante fator de desencadeamento de complicaçöes...