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Pulmonary artery catheters for adult patients in intensive care

  • Review
  • Intervention

Authors


Abstract

Background

Pulmonary artery catheterization was adopted about 30 years ago and widely disseminated without rigorous evaluation as to whether it benefited critically ill patients. The technique is used to measure cardiac output and pressures in the pulmonary circulation to guide diagnosis and treatment. Clinicians believe these data can improve patients' outcomes, even in the absence of consensus about the specific interpretation of the data.

Objectives

To assess the effect of pulmonary artery catheterization on mortality and cost of care in adult intensive care patients.

Search methods

We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 2, 2006); MEDLINE (all records to April 2006); EMBASE (all records to April 2006); CINAHL (all records to April 2006) and reference lists of articles. We contacted manufacturers and researchers in the field.

Selection criteria

We included all randomized controlled trials in adults, comparing management with and without a pulmonary artery catheter (PAC).

Data collection and analysis

We screened the titles and abstracts of the electronic search results and obtained the full text of studies of possible relevance for independent review. We determined the final results of the literature search by consensus between the authors. We did not contact study authors for additional information.

Main results

We identified 12 studies. Mortality was reported as hospital, 28-day, 30-day, or intensive care unit. We considered studies of high-risk surgery patients (eight studies) and general intensive care patients (four studies) separately for the meta-analysis. The pooled odds ratio for the studies of general intensive care patients was 1.05 (95% confidence interval (CI) 0.87 to 1.26) and for the studies of high-risk surgery patients 0.99 (95% CI 0.73 to 1.24). Of the eight studies of high-risk surgery patients, five evaluated the effectiveness of pre-operative optimization but there was no difference in mortality when these studies were examined separately. Pulmonary artery catheterization did not affect intensive care unit (reported by 10 studies) or hospital (reported by nine studies) length of stay. Four studies, conducted in the United States, measured costs based on hospital charges billed to patients, which on average were higher in the PAC groups.

Authors' conclusions

To date, there have been two multi-centre trials of the effectiveness of PACs for managing critically ill patients admitted to intensive care, although only one was adequately powered. Efficacy studies are needed to determine optimal management protocols and patient groups who could benefit from management with a PAC.

Plain language summary

Pulmonary artery catheters for adult patients in intensive care

The pulmonary artery catheter is a device used to measure blood flow and pressures in the heart and lung blood vessels. These measurements are used to guide treatment of critically ill patients or patients undergoing major surgery. Pulmonary artery catheters were first used in intensive care units about 30 years ago, but there is no clear evidence that using them to guide treatment actually allows patients to recover faster, or for more of them to survive their illness.

Twelve trials were identified comparing patients treated with and without the use of a pulmonary artery catheter. These were divided into trials of patients undergoing routine major surgery and trials of patients who were critically ill and admitted to intensive care for more wide-ranging reasons. There were eight trials in the major surgery group and only one was a large trial with nearly 2000 patients. The other trials were conducted in single hospitals and had no more than 120 patients taking part. There were four trials of critically ill patients, and two were large trials: one with nearly 700 patients and one with over 1000 patients. Overall, even though the trials measured numbers of deaths in each group at different points in time, all reported that there were no differences between patients who did and did not have a pulmonary artery catheter inserted. Five trials also measured the costs associated with using a pulmonary artery catheter. Four trials were conducted in the US and showed that on average the charges were higher for patients who had a pulmonary artery catheter. A study in the UK used a different approach to analyse costs of care and concluded that withdrawing the use of the pulmonary artery catheter might result in a cost saving.

Most of the trials identified were small, conducted in a single hospital with less than 200 patients taking part. Most were of patients undergoing routine major surgery. Neither group of patients studied showed any evidence of benefit or harm from a pulmonary artery catheter.

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