alliances and professional education at Edwards Lifesciences in Irvine, California. In a recent publication, the major area of decline occurred in nonsurgical intensive care units. Continued PAC use tends to be in surgical patients, those taking vasopressors, and those receiving mechanical ventilation. Potential rationales for the decline include decreased education or a knowledge deficit in obtaining accurate values and appropriate interpretation, the dearth of published evidence-based practice related to use of PACs, and potential complications when PACs are used. One potential complication that may have led to less use of PACs is pulmonary artery rupture. This complication, although infrequent, can have catastrophic implications. The mean overall incidence of a pulmonary artery rupture is 0.01% to 0.47%; however, mortality has been reported at between 50% and 75% in patients taking anticoagulants. Perforation of the pulmonary artery may occur during insertion of the catheter or subsequent wedging. Patients who are elderly, have pulmonary hypertension, and/or are being treated with anticoagulants may present greater risk. Pulmonary artery systolic and diastolic pressures are monitored A Jan M. Headley, RN, BS, replies: