Right Heart Catheterization: Indications, Technique, Safety, Measurements, and Alternatives

摘要

For over three decades, balloon-tipped right heart catheterization (RHCn) has been employed to assist in the diagnosis, assessment, and management of high-risk patients and interventions. There has been a considerable debate regarding the safety and efficacy of this clinical tool, and even moratorium has been suggested. Currently, even in the face of contemporary noninvasive methods to obtain hemodynamic data, RHCn is still utilized. However, quality randomized clinical trials, assessing the effects RHCn on outcome of well-defined patient's subsets, are clearly lacking. The contemporary indications, technique, and safety issues are discussed. Accurate data acquisition and interpretation are emphasized. Finally, RHC data are compared with hemodynamic information obtained noninvasively by impedance cardiography (ICG), and echocardiograpy and Doppler analysis. Recently, modern pump-function descriptor (cardiac power) derived from cardiac output measurements have emerged. The important interplay between the systemic and pulmonary circulation became increasingly acknowledged. Although modern right heart catheters (RHCs) are able to provide comprehensive, continuous, real-time, and effort-free hemodynamic data, they did not replace the 30-year-old inexpensive RHCs. Regrettably, no noninvasive alternatives can provide all these features. Our educational goals should include more appropriate case selection, along with safer insertion and reliable data acquisition and interpretation. The industry should attempt to incorporate into the monitored intensive care bed, safer systems and devices that provide continuous, 'hands-off', low maintenance, comprehensive and accurate hemodynamic data. RHCn is still an excellent and most comprehensive clinical and research method for hemodynamic assessment and monitoring. It is likely to continue to play a pivotal role in modern intensive care as well as contemporary research. In clinical practice, case selection for RHCn should be based on the clinical questions and dilemmas the patient is presenting. In research, RHCn should be employed whenever noninvasive methods could not reliably obtain data that are required to answer the scientific question.