Relationship of pulmonary artery catheter use to mortality... : Critical Care Medicine (original) (raw)

FEATURE ARTICLES

Relationship of pulmonary artery catheter use to mortality and resource utilization in patients with severe sepsis*

Yu, D. Tony MD, MPH; Platt, Richard MD, MSc; Lanken, Paul N. MD; Black, Edgar MD; Sands, Kenneth E. MD, MPH; Schwartz, J. Sanford MD; Hibberd, Patricia L. MD, PhD; Graman, Paul S. MD; Kahn, Katherine L. MD; Snydman, David R. MD; Parsonnet, Jeffrey MD; Moore, Richard MD; Bates, David W. MD, MSc for the AMCC Sepsis Project Working Group

From the Division of General Medicine (DWB, DTY) and the Channing Laboratory (KES, RP), Department of Medicine, Brigham and Women’s Hospital, and the Department of Ambulatory Care and Prevention (RP), Harvard Medical School, Boston, MA; the Division of Infectious Diseases, Department of Medicine (PLH), Massachusetts General Hospital, Boston, MA; the Pulmonary, Allergy and Critical Care Division (PNL) and the Division of General Internal Medicine, Department of Medicine and the Leonard Davis Institute (JSS), University of Pennsylvania, Philadelphia, PA; Infectious Diseases Unit (PSG) and the Division of General Internal Medicine (EB), Department of Medicine, University of Rochester School of Medicine, Rochester, NY; the Division of General Internal Medicine (KK), University of California at Los Angeles Medical Center, Los Angeles, CA; the Division of Infectious Diseases (DRS), Department of Medicine and Pathology, New England Medical Center and Tufts University School of Medicine, Boston, MA; the Infectious Disease Section (JP), Dartmouth-Hitchcock Medical Center, Lebanon, NH; and the Division of Infectious Diseases, Johns Hopkins Hospital (RM).

Among patients with severe sepsis, there was no association between in-hospital mortality rate or resource use and pulmonary artery catheter placed within 30 hrs of sepsis onset.

Abstract

Objective

To examine the relationship of pulmonary artery catheter (PAC) use to patient outcomes, including mortality rate and resource utilization, in patients with severe sepsis in eight academic medical centers.

Design

Case-control, nested within a prospective cohort study.

Setting

Eight academic tertiary care centers.

Patients

Stratified random sample of 1,010 adult admissions with severe sepsis.

Interventions

None.

Measurements and Main Results

The main outcome measures were in-hospital mortality, total hospital charge, and length of stay (LOS) for patients with and without PAC use. The case-matched subset of patients included 141 pairs managed with and without the use of a PAC. The mortality rate was slightly but not statistically significantly lower among the PAC use group compared with those not using a PAC (41.1% vs. 46.8%, p = .34). Even this trend disappeared after we adjusted for the Charlson comorbidity score and sepsis-specific Acute Physiology and Chronic Health Evaluation (APACHE) III (adjusted odds ratio, 1.02; 95% confidence interval, 0.61–1.72). In linear regression models adjusted for the Charlson comorbidity score, sepsis-specific APACHE III, surgical status, receipt of a steroid before sepsis onset, presence of a Hickman catheter, and preonset LOS, no significant differences were found for total hospital charges (US$139,207 vs. 148,190, adjusted mean comparing PAC and non-PAC group, p = .57), postonset LOS (23.4 vs. 26.9 days, adjusted mean, p = .32), or total LOS in intensive care unit (18.2 vs. 18.8 days, adjusted mean, p = .82).

Conclusions

Among patients with severe sepsis, PAC placement was not associated with a change in mortality rate or resource utilization, although small nonsignificant trends toward lower resource utilization were present in the PAC group.