Pulmonary artery occlusion pressure estimation: How confident are anesthesiologists?

Objective: The pulmonary artery catheter is a controversial device, and randomized evaluation of its effectiveness has been demanded. Accurate estimation of pulmonary artery occlusion pressure is important for optimal use of the pulmonary artery catheter. Anesthesiologists use the pulmonary artery catheter frequently but have not been surveyed about confidence in pulmonary artery occlusion pressure estimation. Our objective was to determine the ability of practicing cardiovascular anesthesiologists to estimate pulmonary artery occlusion pressure accurately and measure their confidence in this estimate. Design: Cross-sectional survey. Setting. All academic and community hospitals in English-speaking Eastern Canada and selected centers in Western Canada and the United States. Patients. Cardiovascular anesthesiologists. Interventions: None. Measurements and Main Results. We measured agreement with expert-defined timing of pulmonary artery occlusion pressure estimation, estimation of a sample pulmonary artery occlusion pressure trace, and management of a hypothetical clinical complication (air embolism). Seventy-seven percent of 345 anesthesiologists responded. Agreement about the optimal timing of pulmonary artery occlusion pressure estimation (89%) and the management of air embolism (85%) was near expectations (expected 90%). However, the pulmonary artery occlusion pressure waveform was interpreted accurately by only 61%, whereas 28% disagreed and 11% were uncertain. Significant positive associations (p =.016) between continuing medical education items and accurate interpretation were observed. Conclusions: Estimation of a sample pulmonary artery occlusion pressure trace by practicing anesthesiologists was in only modest agreement with expert assessment and published standards. Anesthesiologists demonstrated substantially less confidence in pulmonary artery occlusion pressure estimation than in the optimal timing of pulmonary artery occlusion pressure estimation. Before the effectiveness of the pulmonary artery catheter in clinical care can be systematically assessed, efforts are needed to enhance accuracy and consistency of pulmonary artery occlusion pressure estimation.