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January 8, 1997

Effectiveness of Right Heart Catheterization: Time for a Randomized Trial

Author Affiliations

Baystate Medical Center Springfield, Mass

JAMA. 1997;277(2):109-110. doi:10.1001/jama.1997.03540260023016

To the Editor.  —The Editorial by Drs Dalen and Bone1 regarding the use of PA catheters goes too far, especially in view of the widespread reporting by the lay press. None of the trials cited in the Editorial addressed the special problems of patients undergoing cardiac or vascular surgery. In the literature pertaining to surgery for abdominal aortic aneurysms, there was an excessively high risk of perioperative renal failure (10%-20%) reported widely through the early 1970s,2,3 in retrospect largely due to undertreatment of the crystalloid requirement that occurs during and immediately after these procedures. When surgeons adopted the routine use of PA catheters, we began to see rates of abdominal aortic aneurysm repairs reported with serious renal failure rates ranging around 2%, and the associated mortality dropped.4,5 For the last 20 years, PA catheters have been routinely used for these procedures. Admittedly, with other improvements in surgical technique and in

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