Pulmonary Artery Catheterization in Critically Ill Neonates: Dr. Hagler replies

Abstract Background: It is not clear whether pulmonary artery catheter (PAC) placement is beneficial for critically ill patients with heart disease. This study aims to investigate the association of PAC use with 28-day mortality in that population.Methods: The MIMIC-IV database was employed to identify critically ill patients with cardiac disease with or without PAC insertion. The primary outcome was 28-day mortality. Multivariate regression was modeled to examine the association between PAC and outcomes. Additionally, we examined the effect modification by cardiac surgeries. Propensity score matching (PSM) was conducted to validate our findings.Results: No improvement in 28-day mortality was observed among the PAC group compared to the non-PAC group (odds ratio=1.18, 95% CI=1.00-1.38, P=0.049). When stratified by cardiac surgeries, the results were consistent. Patients in the PAC group had fewer ventilation-free days and vasopressor-free days than those in the non-PAC group after surgery stratification. In surgical patients, PAC insertion was not associated with the occurrence of acute kidney injury (AKI), and was associated with a higher daily fluid input (mean difference=0.13, 95% CI=0.05-0.20, P=0.001). In non-surgical patients, the PAC group had a higher risk of AKI occurrence (odds ratio=1.94, 95% CI=1.32-2.84, P=0.001).Conclusion: PAC placement was not associated with survival benefits in critically ill patients with cardiac diseases, either in surgical and non-surgical patients.

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Early Use of the Pulmonary Artery Catheter and Outcomes in Patients with Shock and Acute Respiratory Distress Syndrome

50 Studies Every Anesthesiologist Should Know ◽

10.1093/med/9780190237691.003.0011 ◽

2018 ◽

pp. 55-59

Keyword(s):

Pulmonary Artery ◽

Pulmonary Artery Catheter ◽

Critically Ill ◽

Critically Ill Patients ◽

Control Group ◽

Pulmonary Artery Catheterization ◽

Catheter Group ◽

Improved Outcomes ◽

Pulmonary Artery Catheters ◽

And Control

This case focuses on how pulmonary artery catheters are used in critically ill patients by asking the question: Do critically ill patients benefit from early insertion of a pulmonary artery catheter to help guide management? In critically ill patients, pulmonary artery catheterization did not lead to improved outcomes compared with standard care without catheterization. There were no significant differences in mortality between patients in the pulmonary artery catheter group and control group. There were also no significant differences between patients in the pulmonary artery catheter group and patients in the control group with respect to organ system failure or the need for mechanical ventilation, dialysis, or vasoactive medications. This trial, along with other trials of pulmonary artery catheterization, demonstrates the importance of evaluating widely used technologies that have never been adequately assessed.

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