중환자에서 폐동맥 카테테르로부터 얻은 혈역학적 자료가 진단과 치료에 미치는 영향

Abstract

Background: The hemodynamic status of critically ill patients is poorly predicted from clinical examination and chest x-ray findings, so equipments such as pulmonary artery catheter are needed for monitoring of hemodynamics. The authors undertook this study to evaluate physician's accuracy in predicting hemodynamic profiles, rates of therapeutic change resulting from catheterization and to compare the outcomes with or without therapeutic changes. Methods: Pulmonary artery catheters were inserted in 19 critically ill patients. The physicians accuracy of predicting the hemodynamic profile, the rate of therapeutic changes by monitoring actual hemodynamic profiles were calculated and compared to the outcome between the patients with and without therapeutic change, Results: Hemodynamic profiles were correctly predicted in 63% of all cases. Hemodynamic data from pulmonary artery catheter made the therapeutic plan changed in 53% of all cases. The cardiac index and left ventricular stroke work index were improved and the mortality rate was lower in patients with therapeutic changes, but there were no significant statistical differences between the patients with and without therapeutic changes. Complications occurred in 6 cases but had no effect on patient' s outcome. Conclusions: Hemodynamic data from a pulmonary artery catheter could lead to a more accurate diagnosis and therapeutic changes.