The Impact of the Utilization of PAC - Essay Example

WHAT IS THE VALUE OF USING THE PULMONARY ARTERY CATHETER IN ADULT PATIENTS WHO ARE UNDERGOING CARDIAC SURGERY? Background The PAC is a monitoring device that is still mainly utilized in cardiac surgery to monitor the pressure in the right side of the heart and pulmonary artery. Though PAC is extensively used in cardiac anaesthesia, its use had always incited controversy. Furthermore, the argument whether an invasive monitoring system with cardiac surgeries like PAC is more beneficial than non-invasive monitoring system continues to be a divisive topic in debates. Many researchers have studied the use of PAC during cardiac anaesthesia and have come up with many advantages that non-invasive monitors do not offer. Kaplan et al. (2000) mentioned that catheterization is very useful but its employment may result to a rare risk condition termed as resistance while removing the catheter postoperatively; hence, its removal should be accomplished through surgery. Otherwise, there are no such risks associated. In lieu of this study, Baldwin and Heland (2000) discovered that there were very few incidents of non-sustained ventricular tachycardia associated with transient hypotension during PAC removal. However, there are also some limitations with the use of PAC. Sandham et al. (2003) suggested that when PAC is used for cardiac anaesthesia in high risk patients, it results in increased mortality; they also discovered that PAC has no benefit in standard care for high risk elderly patients. Conversely, Kanchi (2011) revealed that the researchers who count the disadvantages of PAC actually use it in Intensive Care units so if PAC is used in cardiac operating rooms then the advantages outweigh the limitations. He also learned that anaesthesiologists agree upon the indefinite uses of PAC in certain cardiac conditions like coronary artery bypass grafting or CABG with poor left ventricular function, LV aneurysmectomy, recent myocardial infarction or MI, pulmonary hypertension, diastolic dysfunction, acute ventricular septal rupture and insertion of left ventricular assist device or LVAD. Stover et al. (2009) also mentioned some limitations in their research and stated that “Invasiveness bears many risks of deleterious complications”. They studied whether the use of non-invasive techniques like Nexfin HD, a continuous non-invasive blood pressure and cardiac output monitor system, can be as helpful as PAC and concluded that although it is very promising, it is not as reliable as PAC. There are also some ethical considerations in conducting research about PAC because clinical equipoise must be obtained. It occurs when less than 70 percent of clinicians agree upon the beneficial use of PAC which favors the clinical trials (Sprung & Eidelman 1997). Objectives The aim of this study is to find out in what conditions is PAC necessary and to recognize the impact associated with its utilization. Methodology Criteria for inclusion and exclusion of studies in the review Types of studies It is expected to find a substantial diversity in methodological approaches underlying the assessment of value of using PAC in cardiac surgeries. It is not expected to find many studies that are based on a randomized design approach. Yet, it is expected to encounter a substantial number of high-quality studies using quasi-experimental and other approaches for frequently researchers employ a variety of methods to arrive at their findings. The evidence-base will evidently determine the prospects for the type of (statistical or non-statistical) aggregation to determine any result variances. Multiple methodologies for inclusion in subsequent analyses are expected to be used: randomized designs, quasi-experimental designs and regression-based approaches and should be published later than 1997 to show its relevance with contemporary practice. In addition, only documents written in English will be considered to facilitate easier comprehension and interpretation. Types of interventions The systematic review will focus on studies that explicitly discuss the impact of the utilization of PAC. Types of target clients All healthcare organizations, hospitals, and cardiac centres across the globe conducting cardiac surgeries for adults (both males and females aging between 18 and 65 years old) who underwent any of the cardiac surgeries will be included to determine if there any risks associated with different age groups and to employ a wider foundation for deriving results which may provide crucial importance to the study. Since it is expected not to find plenty of work in this field, no studies will be excluded on the basis of client characteristics. Types of outcomes Three levels of impact will be distinguished: a. Positive impact: useful for the outcome of the surgery on patient. b. Negative impact: harmful impact on the patient. c. No impact: neither useful nor harmful impact. Assessment of study quality The systematic review will utilized a general system for critical appraisal which endeavours to identify the major strengths and weaknesses of the studies chosen that will enable to recognize any underlying issues of vital significance. Search strategy for identification of relevant studies The search for articles and papers to be included in the review will be based on a set of keywords and phrases derived from the research aim and questions such as impact, outcomes and benefits of PAC use derived in published, unpublished and electronic databases such as PubMed Central. The search strategy consists of two phases namely; the initial phase which is a broad search for relevant sources in which a limited set of keywords will be used to find potentially relevant studies. These studies will be reviewed in an effort to expand key words and phrases for a more in-depth search; and the subsequent phase which is a second more focused search on a particular type of study and specific type of outcome. The decision will depend on the amount of studies available which are based on randomized and quasi-experimental designs. Three parallel search strategies will be assured for this review such as database searches of published literature and internet searches for published and unpublished research. Potential Ethical Considerations The researcher will employ the use of the proper citation of all included references and work to observe and promote recognition of the variety of ideas formulated in particular by a variety of authors. References Baldwin, I.C., and Heland, M. (2000) Incidence of cardiac dysrhythmias in patients during pulmonary artery catheter removal after cardiac surgery. Heart and Lung, 29 (3), p.155-160. Kanchi, M. (2011) Do we need a pulmonary artery catheter in cardiac anaesthesia?—an Indian perspective. Annals of Cardiac Anaesthesia, 14 (1), p. 25-9. Kaplan, M., Demirtas, M., Cimen, S., Kut, M.S., Ozay, B., Kanca, A. and Ozler, A. (2000) Swan-Ganz catheter entrapment in open heart surgery. Journal of Cardiac Surgery, 15 (5), p. 313-315. Sandham, J.D., Hull, R.D., Brant, R.F., Knox, L., Pineo, G.F., Doig, C.J., Laporta, D.P., Viner, S., Passerini, L., Devitt, H., Kirby, A. and Jacka, M. (2003) A randomized, controlled trial of the use of pulmonary-artery catheters in high-risk surgical patients. The New England Journal of Medicine, 348, p. 5-14. Sprung, C.L., and Eidelman, L.A. (1997) Ethical issues of clinical trials for the pulmonary artery catheter. New Horizons, 5 (3), p. 264-267. Stover, J.F., Stocker, R., Lenherr, R., Neff, T.A., Cottini, S.R., Zoller, B. and Bechir, M. (2009) Noninvasive cardiac output and blood pressure monitoring cannot replace an invasive monitoring system in critically ill patients. BioMed Central Anesthesiology, 9 (6), 12 October 2009. Available from: < http://www.biomedcentral.com/1471-2253/9/6>. [Accessed (Date you accessed this article, remove parenthesis after)]. Read More