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January 8, 1997

Effectiveness of Right Heart Catheterization: Time for a Randomized Trial

JAMA. 1997;277(2):111-112. doi:10.1001/jama.1997.03540260025022

To the Editor.  —As the Executive Committee of the Board of Directors of American Society of Critical Care Anesthesiologists, the largest American subspecialty group of anesthesiologists and intensivists, we write to raise several points about the recent article by Dr Connors and colleagues on the RHC1 and its accompanying Editorial.2We commend Connors et al for their attempt to examine the efficacy and safety of the RHC in a large cohort of critically ill (medical) patients. Their finding that the use of the RHC "was associated with an increased risk of mortality" certainly warrants further investigation. The explanations proposed by the authors are interesting, raising the possibility that the aggressive, interventional style of management practiced in some ICUs is hazardous rather than beneficial.An alternative explanation, that the "benefits of RHC may not be realized if the physician interpreting the output of the catheter is not knowledgeable and skilled in its