To the Editor.
—Perhaps the Editorial by Drs Dalen and Bone1 should have specified a moratorium on the use of flowdirected PA catheters in the subset of patients who were observed by Dr Connors and colleagues2: patients with acute respiratory failure, chronic obstructive pulmonary disease, congestive heart failure, cirrhosis, nontraumatic coma, colon cancer metastatic to the liver, non-small cell lung cancer, and multiorgan system failure. Right heart catheterization has been shown to be beneficial for certain patients with trauma, head injury, and subarachnoid hemorrhage who were not included in this study.Cerebral vasospasm and subsequent delayed cerebral ischemia are the major cause of death and disability in patients who initially survive cerebral aneurysm rupture. By increasing cerebral blood flow, hypertensive hypervolemic hemodilution ("triple-H" therapy) has been shown to reduce the incidence of clinical vasospasm and to reverse neurologic deficits that develop in patients with cerebral vasospasm.3 Right heart catheterization and
Jackson RJ. Effectiveness of Right Heart Catheterization: Time for a Randomized Trial. JAMA. 1997;277(2):108-109. doi:10.1001/jama.1997.03540260022013