The pulmonary artery catheter, although controversial, has demonstrated continued usefulness in differentiating shock states, defining the etiologies of respiratory and cardiac failure, and assessing intracardiac shunts and regurgitation of mitral and tricuspid valves. The PAC also has use in several specific surgical situations involving large fluid shifts or potential cardiac damage, such as liver transplantation, aortic cross-clamp cases, and large operating room (OR) cases involving renal-failure patients. Although PACs were traditionally used to guide therapy in patients with acute myocardial infarct, recent studies have shown that PAC tracings are marginally beneficial in sensing ischemia, except in the instance of intraoperative right ventricular ischemia.

Perioperative use of the pulmonary artery catheter is common in the intensive care unit (ICU) setting. Many patients in the ICU suffer multiple organ dysfunctions, and data from PACs are useful in detecting and defining various hemodynamic disturbances for therapy implementation. Infection becomes a greater risk with ICU use, particularly for more than 6 days.

Pulmonary artery catheterization may be complicated by adverse events that occur during access of the central venous system, positioning of the PA catheter, and catheter “residence”. According to American Society of Anesthesiologists (ASA) 2003 data (Table 23.1), the most common complication in obtaining central venous access is postoperative neuropathy, followed by arterial puncture, air embolism, and pneumothorax. Placement of the PAC commonly causes minor dysrhythmias (4.7% to 68.9% reported incidence), followed by ventricular tachycardia or fibrillation, right bundle branch block, and complete heart block preceded by left bundle branch block; the catheter may also coil or knot. Once it is in place, the PAC can rupture the pulmonary artery (0.1% to 1.5% reported incidence), become infected and lead to sepsis, or cause thrombophlebitis, venous thrombosis, pulmonary infarction, mural thrombus, or valvular or endocardial vegetations. Deaths attributed to pulmonary artery catheters have a reported incidence of 0.02% to 1.5%.