on the Past 6 Years

of which have already achieved “landmark ” status, and to specifically address the utility of monitoring cardiac filling pressures. Historical Overview: 1970-2000 The PAC was developed by Swan, Ganz, et al2 and revealed in their milestone publication in 1970. The clinical utility of the catheter was established in 1976, when a 2-part article was published demonstrating that patients with myocardial infarction and hemody-namic compromise could be managed by application of catheter derived hemodynamic subsets.3,4 Within the next decade, several investigations appeared to show that use of these catheters in patients suffering from a wide variety of hemodynamic abnormalities and insults markedly improved outcomes. Of greatest interest to anesthesiologists were the studies that purported to demonstrate that periopera-tive pulmonary artery catheterization, usually combined with rigorous intensive care unit (ICU) management, resulted in dramatically lower morbidity and mortality. The pulmonary artery catheter (PAC) has beenthe mainstay of invasive hemodynamic monitor-ing for 35 years. Despite the tens of millions of catheters used, it is probably the most controversial invasive medical device ever introduced into clinical practice. Over the past 6 years, since the Updated Report by the American Society of Anesthesiologists Task Force on Guidelines for Pulmonary Artery Catheterization was written,1 several large, statistically sound studies have been published that should directly affect the way anesthesiologists choose to use this monitor in their practice. It is the goal of this article to give a historical overview of the first 30 years of litera-ture, to review the newer studies in greater depth, som