Effectiveness of Right Heart Catheterization: Time for a Randomized Trial

To the Editor. —The article by Dr Connors and colleagues 1 on RHC raised significant concerns about this diagnostic procedure for the members of the Society of Critical Care Medicine (SCCM). The balloon-tipped, flow-directed PA catheter has been an essential part of the cardiac diagnostic armamentarium since the inception of the SCCM 25 years ago. An important part of fellowship training in critical care is learning how to interpret information from RHC and how to develop the expertise to make therapeutic judgments based on that information. Thus, both the SCCM Council and I reacted strongly to the article and accompanying Editorial by Drs Bone and Dalen. 2 We were concerned that the influence of the article and the Editorial might cause physicians to change practice before the findings of this article and others critical of RHC are scientifically clear. Future projects must sort out the risk of the procedure itself vs the risk