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

Crit Care Med. 2003 Dec;31(12):2734-41. doi: 10.1097/01.CCM.0000098028.68323.64.

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 (139,207 US dollars 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.

MeSH terms

  • APACHE
  • Academic Medical Centers
  • Aged
  • Analysis of Variance
  • Case-Control Studies
  • Catheterization, Swan-Ganz / adverse effects
  • Catheterization, Swan-Ganz / statistics & numerical data*
  • Comorbidity
  • Confounding Factors, Epidemiologic
  • Critical Care / methods
  • Critical Care / statistics & numerical data
  • Female
  • Health Resources / statistics & numerical data*
  • Hospital Charges / statistics & numerical data
  • Hospital Mortality*
  • Humans
  • Length of Stay / statistics & numerical data
  • Linear Models
  • Logistic Models
  • Male
  • Middle Aged
  • Prospective Studies
  • Risk Factors
  • Sepsis / mortality*
  • Sepsis / therapy*
  • Treatment Outcome
  • United States / epidemiology