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January 8, 1997

Effectiveness of Right Heart Catheterization: Time for a Randomized Trial

Author Affiliations

Minneapolis Heart Institute Shakopee, Minn

JAMA. 1997;277(2):111. doi:10.1001/jama.1997.03540260025020

To the Editor.  —The study by Dr Connors and colleagues1 has reignited the controversy surrounding the use of the PA catheter in critically ill patients. I do not argue with the results of this well-conducted study, but I wonder why the authors have restricted their focus to the procedure of RHC. Would the results be similar if the authors had tested other procedures commonly performed in the critically ill such as central venous catheterization, intubation and mechanical ventilation, and catheterization of the urinary bladder? Perhaps it is the insertion of a central venous catheter (not the RHC itself) that is associated with increased mortality.The 30-day survival curves shown in Figure 21 are of interest. The curves begin to diverge at hospital day 5 and diverge even further between days 5 and 30. Do the authors propose that RHC on day 1 is somehow responsible for this progressive difference in survival?