Lung transplantation. The indications and selection criteria]

OBJECTIVE: To survey physicians' attitudes toward the pulmonary artery catheter (PAC) and to assess physicians' knowledge of pulmonary artery catheterization. DESIGN: Mail survey/examination. PARTICIPANTS: Physician members of the Society of Critical Care Medicine in the United States. METHODS: A 51-question two-part survey was mailed to U.S. Society of Critical Care Medicine physician members by an independent research firm. The participants were instructed to answer the questions unassisted and to return the survey within one month. The first 20 questions surveyed physicians' attitudes toward the PAC. The remaining 31 multiple-choice questions tested the physicians' knowledge of the PAC and its use. The multiple-choice questions were obtained from a previous study which assessed physicians' knowledge of pulmonary artery catheterization. RESULTS: Five thousand surveys were mailed in October of 1996; 1095 surveys were returned in November of 1996, yielding a 22% return rate. The survey results were significant in that 95% of the respondents felt that a moratorium against PAC use was not warranted and that 75% of the respondents favored a prospective, randomized, controlled trial involving pulmonary artery catheterization. The mean test score for the multiple-choice questions was 25.6 (82.6%) with a standard deviation of +/- 3.46 and a range of 3 to 31 (10%-100%). The mean score was found to be significantly associated (p <0.001) with the following variables: specialty, practice pattern, number of PAC insertions performed per month, and whether or not the physician was trained and/or certified in critical care medicine. One third of respondents incorrectly identified the pulmonary artery occlusion pressure on a clear tracing and could not identify the major components of oxygen transport. CONCLUSION: The results of this mail survey/examination reflect the current attitudes and knowledge of the responding U.S. physician members of the Society of Critical Care Medicine regarding the PAC. The majority of the respondents are in favor of a prospective, randomized, controlled trial involving the PAC; 95% of the respondents feel that a moratorium on further use of the PAC is currently not warranted. Rather than a call for such a moratorium, a call for the development and maintenance of educational, credentialing, and continuous quality improvement policies involving the PAC is warranted and overdue.