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Effectiveness of right heart catheterization: time for a randomized trial.

To the Editor. —Drs Dalen and Bone 1 recommend that either a randomized trial be conducted to determine if pulmonary artery (PA) catheterization is beneficial or the FDA should issue a moratorium on the use of flow-directed PA catheters. This recommendation was based largely on the findings of Dr Connors and the SUPPORT Investigators 2 that patients with PA catheters had a higher associated mortality and hospital cost. However, this study did not include large numbers of patients who are commonly managed with RHC: patients undergoing major surgical procedures, patients with major burns, and patients with severe trauma. Although these patients are at risk for mortality, they do not qualify as having organ system failure. Several prospective randomized studies in surgical patients have demonstrated benefits of PA catheterization in selected patient populations. 3-5 While Connors et al may have cast doubt on the benefits of PA catheters in a group of patients with