U. doctors help write medical policy

Five clinical specialists from the University of Pennsylvania Medical Center were among a prestigious group of medical leaders chosen to help develop national guidelines for the use of pulmonary artery catheters at a conference August 25 and 26 in Alexandria, Va. Pulmonary artery catheters are synthetic tubes inserted into peripheral veins either in the neck, chest or groin. They are then manipulated through the circulation into the pulmonary artery where they are used to measure pressures. The National Heart, Lung and Blood Institute and the Food and Drug Administration organized the Workshop on Pulmonary Artery Catheterization and Clinical Outcomes in response to recent studies which suggested that catheters lead to increased mortality rates. The workshop attempted to develop practical guidelines for the use of pulmonary artery catheters, discussed credentialing physicians and nurses on catheter usage and examined the benefits and risks associated with the procedure. Catheter usage has increased sharply over the past 25 years, and more than 1 million are used each year in the United States alone. Harold Palevsky -- director of the University's Pulmonary Vascular Disease Program -- explained that catheters are machines used to help patients with a variety of medical conditions. "The pulmonary artery catheter is employed daily to obtain data to help physicians determine, monitor and modify therapy in critically ill patients, including those with complicated heart attacks, respiratory heart failure, congestive heart failure and primary pulmonary hypertension, to name a few," he said. Palevsky described the PACCO workshop as an important step in dealing with the controversy surrounding catheters. "Many physicians -- especially those in intensive-care settings -- have been greatly affected by the controversy generated by recent studies," he said. He noted that there is a lack of scientific evidence regarding the use of pulmonary artery catheters and stressed that the subsequent controversy has forced the National Heart, Lung and Blood Institute and the FDA to develop practical guidelines for the safe use of pulmonary artery catheters in the care of critically ill patients. The five University doctors chosen to attend the conference were Palevsky, Medicine Professor Sanford Schwartz, Assistant Surgery Professor Jeffrey Carpenter, Assistant Anesthesia Professor William Hanson and Cardiothoracic Surgery Professor Henry Edmunds. The first day of the conference included group sessions on topics such as respiratory and cardiovascular diseases, while the second day included presentations on the state of knowledge concerning the use of pulmonary artery catheters. Leaders from each group met on the second day to present recommendations on catheter policy and suggest research possibilities on the subject.