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Pulmonary artery catheters for adult patients in intensive care

  1. Sujanthy S Rajaram1,*,
  2. Nayan K Desai1,
  3. Ankur Kalra2,
  4. Mithil Gajera3,
  5. Susan K Cavanaugh4,
  6. William Brampton5,
  7. Duncan Young6,
  8. Sheila Harvey7,
  9. Kathy Rowan7

Editorial Group: Cochrane Anaesthesia Group

Published Online: 28 FEB 2013

Assessed as up-to-date: 31 JAN 2012

DOI: 10.1002/14651858.CD003408.pub3


How to Cite

Rajaram SS, Desai NK, Kalra A, Gajera M, Cavanaugh SK, Brampton W, Young D, Harvey S, Rowan K. Pulmonary artery catheters for adult patients in intensive care. Cochrane Database of Systematic Reviews 2013, Issue 2. Art. No.: CD003408. DOI: 10.1002/14651858.CD003408.pub3.

Author Information

  1. 1

    Cooper Medical School of Rowan University (CMSRU) and UMDNJ/RWJ Medical School, Cooper University Hospital, Department of Medicine, Camden, NJ, USA

  2. 2

    Minneapolis Heart Institute at Abbott Northwestern Hospital/Hennepin County Medical Center, Section of Cardiovascular Medicine, Minneapolis, MN, USA

  3. 3

    Christiana Care Health System, Department of Medicine, Newark, DE, USA

  4. 4

    Cooper University Hospital, CMSRU, Medical Library, Camden, NJ, USA

  5. 5

    Aberdeen Royal Infirmary, Department of Anaesthetics, Aberdeen, Scotland, UK

  6. 6

    John Radcliffe Hospital, Adult Intensive Care Unit, Oxford, UK

  7. 7

    Intensive Care National Audit & Research Centre, London, UK

*Sujanthy S Rajaram, Department of Medicine, Cooper Medical School of Rowan University (CMSRU) and UMDNJ/RWJ Medical School, Cooper University Hospital, One Cooper Plaza, Camden, NJ, 08103, USA. rajaram-sri-sujanthy@cooperhealth.edu. sujanty@gmail.com.

Publication History

  1. Publication Status: New search for studies and content updated (conclusions changed)
  2. Published Online: 28 FEB 2013

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Characteristics of included studies [ordered by year of study]
Shoemaker 1988

MethodsRandomized by cards arranged according to random numbers tables, by an outside person, placed in sealed opaque envelopes opened in sequence.


ParticipantsEntry criteria:
patients with one or more of 11 high risk criteria previously defined and associated with a mortality rate close to 30%.
Exclusion criteria:
none stated.


InterventionsPAC standard group (n = 30) - transfer to ICU. PAC placed followed by standard management to achieve normal values of haemodynamic and oxygen transport variables
PAC protocol group (n = 28) - transfer to ICU, PAC placed followed by treatment to achieve supra-normal haemodynamic and oxygen transport values.
Control group (n = 30) - CVC placed. Standard care. Not reported if managed in ICU preoperatively


OutcomesMortality and morbidity (statistic not specified). Main outcome not stated. Also reported ICU and hospital LOS.


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)High riskTwo series of patients in both groups and number of patients were not randomized. Series one randomization was not clear, series 2, some patients were randomized postoperatively, some preoperatively and some are not randomized.

Allocation concealment (selection bias)Low riskDesignated by cards arranged according to a random number table by an outside person, placed in opaque sealed envelope

Blinding of participants and personnel (performance bias)
primary outcome
High riskNot blinded, but providers were rotated in both control and treatment groups

Blinding of outcome assessment (detection bias)
primary outcome
High riskNot blinded

Incomplete outcome data (attrition bias)
alloutcomes
Low riskAll outcome data are reported

Selective reporting (reporting bias)Low riskReported all outcome data

Other biasHigh riskSeries 1 had high-risk surgical patients and series 1 had low-risk surgical patients, but when physicians felt some patients were not candidates for invasive monitoring they were excluded from the study or included postoperatively.

Pearson 1989

MethodsRandomized using a table of random numbers (no other details given).


ParticipantsEntry criteria:
scheduled for elective cardiac surgery.
Exclusion criteria:
none given.


InterventionsPAC 1 group (n = 86) - standard PAC placed.
PAC 2 group (n = 66) - mixed venous oxygen measuring PAC placed.
Control group (n = 74) - CVC placed.


OutcomesICU mortality
ICU LOS
Costs of care. Main outcome not stated.


NotesOf the 74 patients randomized to the control group, 46 were reassigned following randomizations to one of the PAC groups for "ethical" reasons.


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)High risk46 patients were reassigned to PAC after randomization

Allocation concealment (selection bias)Low riskUsed a table of random numbers

Blinding of participants and personnel (performance bias)
primary outcome
High riskNot blinded in fact allowed to change the group after randomizations

Blinding of outcome assessment (detection bias)
primary outcome
High riskNo blinding done

Incomplete outcome data (attrition bias)
alloutcomes
Low riskReported all the cost, LOS and mortality outcomes

Selective reporting (reporting bias)Low riskNone

Other biasHigh riskAdditional groups 4 and 5 were included due to reassignment of groups after randomizations can cause unknown bias

Joyce 1990

MethodsPreoperative randomization into two groups.


ParticipantsEntry criteria:
elective infra-renal aortic reconstructive surgery.
Exclusion criteria:
unstable angina; recent myocardial infarction (last 6 months); left ventricular ejection fraction less than 50%.


InterventionsPAC group (n = 21) - PAC placed (no management protocol).
Control group (n = 19) - CVC placed (no management protocol).


OutcomesMain outcome was postoperative cardiac complications (defined). Also reported 30-day postoperative mortality.


NotesA non-randomized group (n = 11) were included in the analyses.


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Low riskUsed "sealed envelope technique"

Allocation concealment (selection bias)Low riskSealed envelopes are concealed allocation

Blinding of participants and personnel (performance bias)
primary outcome
Unclear riskInsufficient information to judge

Blinding of outcome assessment (detection bias)
primary outcome
Unclear riskInsufficient information to judge

Incomplete outcome data (attrition bias)
alloutcomes
Low riskReported all data

Selective reporting (reporting bias)Low riskReported all outcomes

Other biasLow riskNone

Isaacson 1990

MethodsRandomized using marked cards.


ParticipantsEntry criteria:
elective aortic reconstructive surgery.
Exclusion criteria:
uncorrectable coronary artery disease; cor pulmonale; severe heart failure; cardiomyopathy; left ventricular ejection fraction less than 40%; symptomatic valvular disease; renal failure; severe restrictive/obstructive pulmonary disease.


InterventionsPAC group (n = 49) - PAC placed before induction of general anaesthesia.
Control group (n = 53) - CVC placed before induction of general anaesthesia.


OutcomesHospital mortality, ICU LOS, hospital LOS, costs of care. Main outcome not stated.


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Low riskUsed marked cards, shuffled

Allocation concealment (selection bias)Low riskUsed faced down cards and made sure investigator would not know which monitor patient would receive

Blinding of participants and personnel (performance bias)
primary outcome
High riskNot blinded same group who did the study made the patient care decision as well

Blinding of outcome assessment (detection bias)
primary outcome
High riskNot blinded

Incomplete outcome data (attrition bias)
alloutcomes
Low riskNo missing out come data

Selective reporting (reporting bias)Low riskFollowed prespecified protocol

Other biasLow riskNone

Guyatt 1991

MethodsRandomization blocked according to a computer-generated list of random numbers in groups of four for each unit. Participating physicians were not aware of the blocking. Envelopes were prepared in sequential order for each unit and were checked daily.


ParticipantsEntry criteria:
assisted ventilation;
hypotension with CVP of 10cm H2O or more;
oliguria with CVP 10cm H2O or more;
oliguria with hypoxaemia;
hypoxaemia and CVP less than 10cm H2O;
physician believed patient might benefit from a PAC.
Exclusion criteria:
PAC ethically contraindicated;
PAC an ethical imperative;
PAC placed preoperatively for intraoperative monitoring;
organ transplant surgery;
receiving high frequency jet ventilation;
consent from a close relative not obtained.


InterventionsPAC group (n = 16) - PAC placed and used at the discretion of the attending physician (no management protocol).
Control group (n = 17) - standard care without a PAC.


OutcomesMain outcome mortality (mortality statistic not specified). Secondary outcome ICU LOS.


NotesTrial stopped early because of poor recruitment.


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Low riskComputer generated sequence

Allocation concealment (selection bias)Low riskPhysicians were not aware of blocks and used envelopes

Blinding of participants and personnel (performance bias)
primary outcome
High riskNot blinded and allowed to cross-over to PAC group

Blinding of outcome assessment (detection bias)
primary outcome
High riskNot blinded and allowed to change the group if physician felt ethically need PAC

Incomplete outcome data (attrition bias)
alloutcomes
Low riskReported all data including cross-over data

Selective reporting (reporting bias)Low riskReported all outcomes

Other biasHigh riskHigh risk of contaminating the randomized group by allowing the sicker patients to cross-over to PAC group may have contributed to high mortality reported

Berlauk 1991

MethodsRandomized using random number generator. Patients entered consecutively in order of appearance on the surgical schedule. No other details given.


ParticipantsEntry criteria: scheduled to receive an in situ vein graft bypass for lower limb vascular insufficiency. Exclusion criteria: myocardial infarction within 3 months; coronary artery bypass graft within 6 weeks; uncompensated congestive heart failure; severe valvular disease; unstable angina.


InterventionsPAC 1 group (n = 45) - transfer to ICU, PAC placed followed by "tune-up" treatment (using predefined end points) at least 12 hrs preoperatively.
PAC 2 group (n = 23) - transfer to anaesthetic holding area, PAC placed followed by "tune-up" treatment (using predefined end points) at least 3 hrs preoperatively.
Control group (n = 21) usual care without a PAC. Arterial catheters and CVCs placed.


OutcomesMain outcome cardiovascular complications. Secondary outcomes were immediate postoperative graft thrombosis and adverse intra-operative events. Also reported mortality (not specified), ICU LOS, hospital LOS.


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Low riskUsed random number generator (Statworks)

Allocation concealment (selection bias)Unclear riskEligible patients were entered consecutively in order of the surgical schedule, no central allocation used, anaesthesiologist may have foreseen allocation while screening for eligibility

Blinding of participants and personnel (performance bias)
primary outcome
Unclear riskAppears to be the study group treated the patients postoperatively

Blinding of outcome assessment (detection bias)
primary outcome
Low riskAnesthesioloist cared for initial 18 hours and unlikely to influence LOS and mortality

Incomplete outcome data (attrition bias)
alloutcomes
Low riskReported all outcome data

Selective reporting (reporting bias)Low riskReported all predefined outcome data

Other biasLow riskNone

Bender 1997

MethodsRandomized but methods not described.


ParticipantsEntry criteria: scheduled for elective infrarenal aortic reconstruction or lower limb revascularize (by a single surgeon). Exclusion criteria: anticipated need before surgery for suprarenal or supra-coeliac aortic clamping; myocardial infarction within 3 months or inadequately controlled angina; poorly compensated congestive heart failure; coronary artery bypass surgery within 6 weeks; symptomatic aortic/mitral valvular disease.


InterventionsPAC group (n = 51) - transfer to ICU, PAC placed followed by "optimizations" preoperatively using a treatment algorithm.
Control group (n = 53) - standard care without a PAC. Arterial catheter and CVC placed.


OutcomesAdverse outcomes (defined) including 30-day mortality, ICU LOS, hospital LOS. Main outcome not stated.


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)High riskPatients were assigned randomly by the surgical intensivist

Allocation concealment (selection bias)High riskIntensivist assigned patients, not concealed at all

Blinding of participants and personnel (performance bias)
primary outcome
High riskNot blinded. Patients were chosen.

Blinding of outcome assessment (detection bias)
primary outcome
High riskSame physician analysed data and cared for all patients, not blinded for any outcome

Incomplete outcome data (attrition bias)
alloutcomes
Unclear riskDid not report about patients who did not get PAC postoperatively in group 2

Selective reporting (reporting bias)High riskPostoperative non-PA catheter group data is not reported and no tables or number of patients

Other biasHigh riskOne surgical intensivist cared for all 104 patients reported and the unreported group of patients for the LOS of 27 days at times reported is likely to create several unknown bias

Valentine 1998

MethodsRandomized using sealed envelopes. No other details given.


ParticipantsEntry criteria:
elective abdominal aortic reconstruction.
Exclusion criteria:
myocardial infarction within 3 months; coronary artery bypass surgery within 6 weeks; severe aortic/mitral valve disease; unstable angina/recent change in angina symptoms; clinically overt congestive cardiac failure; advanced chronic renal insufficiency; repeat aortic operations; additional procedures, e.g. renal artery bypass grafting performed.


InterventionsPAC group (n = 60) - transfer to ICU, PAC placed followed by "tune-up" treatment (using predefined end points used be Berlauk et al) at least 14 hrs preoperatively.
Control group (n = 60) not transferred to ICU, CVC placed and no specific preoperative treatment.


OutcomesAdverse postoperative events (defined), duration of ventilation,
ICU LOS and hospital LOS, hospital mortality.
Main outcome not stated.


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Low riskUsed sealed envelopes

Allocation concealment (selection bias)Unclear riskNot mentioned how allocation was done

Blinding of participants and personnel (performance bias)
primary outcome
Unclear riskNot mentioned if the study group also treated the patients

Blinding of outcome assessment (detection bias)
primary outcome
Unclear riskNot mentioned study reviewers were blinded from knowing or altering the outcome

Incomplete outcome data (attrition bias)
alloutcomes
Low riskReported all predefined outcome data

Selective reporting (reporting bias)Low riskNo selective reporting

Other biasLow riskTwo control group patients were transferred over to PAC but did not include them in analysis

Rhodes 2002

MethodsRandomized using computer generated random numbers stored in sealed envelopes.


ParticipantsEntry criteria:
either circulatory shock (definition given); oliguria (definition given); requirement for vasoactive infusion; need for mechanical ventilation.
Exclusion criteria:
less than 18 yrs of age; admitted to ICU for preoperative optimizations.


InterventionsPAC group (n = 96) - PAC placed (no management protocol).
Control group (n = 105) - standard care without a PAC or any other form of cardiac output monitoring.


OutcomesMain outcome 28-day mortality.
Secondary outcomes ICU LOS, hospital LOS and morbidity.


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Low riskQuirk of computer generated sequence

Allocation concealment (selection bias)Low riskSealed envelopes

Blinding of participants and personnel (performance bias)
primary outcome
Low riskDouble blinding of the study was not feasible, but treating physicians were not prelocalized to follow a path, allowed to treat clinically and remove PAC if felt the need does not exist, less likely to influence the outcome

Blinding of outcome assessment (detection bias)
primary outcome
Low riskStudy outcome assessment was done later on and treating physicians were not given instructions to follow a protocol and end result

Incomplete outcome data (attrition bias)
alloutcomes
Low riskAll data are reported including the PAC group who did not get the catheter, included in the analysis

Selective reporting (reporting bias)Low riskNone

Other biasLow riskWell covered without any bias

Sandham 2003

MethodsRandomized using computer generated sequence concealed in sealed, opaque consecutively numbered envelopes. Stratified according to type of surgery, ASA class and blocked according to centre.


ParticipantsEntry criteria:
Age >60; American Society of Anesthesiologists class III or IV risk; scheduled for urgent/elective major abdominal, thoracic, vascular or orthopaedic surgery.
Exclusion criteria: none stated.


InterventionsPAC group (n = 997) - PAC placed prior to surgery, followed by treatment directed to predefined physiological goals.
Control group (n = 997) - standard care without a PAC. Placement of CVC permitted.


OutcomesMain outcome hospital mortality. Secondary outcome hospital LOS.


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Low riskComputer generated sequence

Allocation concealment (selection bias)Low riskSealed envelopes used

Blinding of participants and personnel (performance bias)
primary outcome
Low riskSingle blind, not double, not feasible but large multicentre trial unlikely to introduce bias

Blinding of outcome assessment (detection bias)
primary outcome
Low riskBlinded assessment of outcome done

Incomplete outcome data (attrition bias)
alloutcomes
Low riskNone

Selective reporting (reporting bias)Low riskWell reported

Other biasLow riskNone

Richard 2003

MethodsRandomized using 24-hour, 7 day-a-week, central telephone service.


ParticipantsEntry criteria:
circulatory shock (definition given) for less than 12 hours and/or acute respiratory distress syndrome (definition given) for more than 24 hours.
Exclusion criteria:
less than 18 years; haemorrhagic shock; myocardial infarction complicated by cardiogenic shock; thrombocytopaenia (platelets <10,000 mm-3); participated in other trials in the last 30 days; were moribund; physician refused to agree with use of full life support.


InterventionsPAC group (n = 335) - PAC placed (no management protocol).
Control group (n = 341) - standard care without a PAC.


OutcomesMain outcome 28-day mortality.
Secondary outcomes 14-day mortality,
90-day mortality,
ICU LOS, hospital LOS.


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Low riskPermuted block algorithm with stratification of each centre

Allocation concealment (selection bias)Low riskCentral randomizations by telephone 24 hours a day 7 days a week

Blinding of participants and personnel (performance bias)
primary outcome
Low riskNo standardized protocols and analysis was not done by treating physicians

Blinding of outcome assessment (detection bias)
primary outcome
Low riskOutcome assessment was blinded to study personal and unbinding of others is not likely to induce bias, multi-entered nature

Incomplete outcome data (attrition bias)
alloutcomes
Low riskNone missing

Selective reporting (reporting bias)Low riskReported specifically

Other biasLow riskNone

Harvey 2005

MethodsRandomized using a 24-hour, 7 day-a-week, central telephone randomization service and minimized by unit, age group, presumptive clinical syndrome, surgical status.


ParticipantsEntry criteria: deemed to require management with a PAC by the treating clinician.
Exclusion criteria: less than 16 years; admitted electively for preoperative optimizations; PAC already in situ on admission to ICU; previously enrolled into the trial; declared brain dead with PAC placed prior to organ donation.


InterventionsPAC group (n = 506) - PAC placed (no management protocol).
Control (n = 508) - standard care without a PAC but with the option to use alternative cardiac output monitoring devices if the unit had opted to be in stratum B.


OutcomesPrimary outcome hospital mortality. Secondary outcomes ICU LOS, hospital LOS, organ-days of support in ICU, costs of care.


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Low riskMinimization was described

Allocation concealment (selection bias)Low riskUsed a central 24 hour telephone service

Blinding of participants and personnel (performance bias)
primary outcome
Low riskNot blinded, not likely influence the results due to multicentre trial and investigators are not providers

Blinding of outcome assessment (detection bias)
primary outcome
Low riskInvestigators were blinded

Incomplete outcome data (attrition bias)
alloutcomes
Low riskNone

Selective reporting (reporting bias)Low riskNone

Other biasLow riskNone

NHLBI 2006

MethodsRandomized multicentre factorial study, patients with acute lung injury for 48 hours or less, randomly assigned in permuted blocks of eight to receive a PAC or a CVC with the use of an automated system.

Patients were simultaneously randomly assigned to a strategy of either liberal or conservative use of fluids guided by a protocol.


ParticipantsInclusion criteria: patients receiving positive pressure ventilation by tracheal tube and had a ratio of the partial pressure of arterial oxygen (PaO2) to the fraction of inspired oxygen (FiO2) below 300 and bilateral infiltrates on chest radiography consistent with the presence of pulmonary edema not due to left atrial hypertension.

Exclusion criteria: presence of a PA catheter after the onset of acute lung injury, presence of acute lung injury for more than 48 hours, inability to obtain consent, presence of chronic conditions that could independently impair survival or weaning or compliance with protocol such as dialysis, severe lung or neuromuscular disease, irreversible conditions and estimated six month mortality rate exceeded 50% such as cancer.


InterventionsAll patients received low tidal volume ventilation according to ARDS network protocol within one hour after randomizations and continued until day 28 or until breathing without assistance.

PAC or CVC was inserted within 4 hours after randomizations. Haemodynamic management as dictated by the protocol was started within the next 2 hours and continued for 7 days or until 12 hours after the patient was able to breathe without assistance. PAC was allowed to be replaced by a CVC if haemodynamic stability defined by the absence of protocol directed interventions for > than 24 hours was achieved after day 3.


OutcomesFour main protocol variables were measured. Blood pressure and urinary output guided management was in both groups. PAOP and CI in the PAC group and CVP and clinical assessment (skin temperature and appearance, rate of capillary refilling) in the CVC group guided management. Outcome measures were reversal of hypotension, oliguria and ineffective circulation. Fluid therapy either crystalloids or colloids and vasopressors were used as per the judgement of the physician, but weaning from vasopressors was done as per protocol.


NotesLactate levels, mixed venous or superior vena cava oxygen saturation were not used.


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Low riskUsed an automated system in permuted blocks of eight

Allocation concealment (selection bias)Unclear riskNot mentioned

Blinding of participants and personnel (performance bias)
primary outcome
High riskNot blinded

Blinding of outcome assessment (detection bias)
primary outcome
High riskNot blinded

Incomplete outcome data (attrition bias)
alloutcomes
Low riskOnly one lost to follow-up in control group

Selective reporting (reporting bias)Low riskPublished reports included all outcomes

Other biasHigh riskTwo different randomizations were done simultaneously (conservative and liberal fluid therapy and PAC versus CVC)

 
Characteristics of excluded studies [ordered by study ID]

StudyReason for exclusion

Bach 1992Not an RCT of management with PAC compared with management without a PAC

Barone 2001Review and meta-analysis

Boldt 1995Not an RCT of management with PAC compared with management without a PAC

Bonazzi 2002Patients assigned to the control group were not transferred to ICU of HDU following surgery

Boyd 1993Not an RCT of management with PAC compared with management without a PAC

Brazzi 1995Not an RCT of management with PAC compared with management without a PAC

Cobb 1992Not an RCT of management with PAC compared with management without a PAC

Cohen 1998Not an RCT of management with PAC compared with management without a PAC

Eyer 1990Not an RCT of management with PAC compared with management without a PAC

Girbes 1999Study end point was the commencement of surgery

Holmes 1997Not an RCT

Kearns 1993Summary of a previously reported RCT

Latour-Perez 1997Not an RCT

Mermel 1991Not an RCT

Mitchell 1992Not an RCT of management with PAC compared with management without a PAC

Orlando 1985Conference abstract only

Raybin 1989Letter

Schultz 1985Not all patients assigned to the control group were transferred to ICU or HDU following surgery

Senagore 1987Not an RCT of management with a PAC compared with management without PAC

Shoemaker 1990Patients were randomly allocated in the second part of the study only. In addition, there was no clear data on mortality in the two groups

Sola 1993Review article

Stewart 1998Not an RCT

Stout 2006Randomized part of this trial is to be cardiac output (CO) (indocyanine green (ICG)) or not and didn't include PACs. PACs and CO (TD) are only referred to in the literature review part of the study

Stubbig 1992Not an RCT of management with PAC compared with management without a PAC

Suttner 2006Not an RCT, PAC compared with thoracic electrical bioimpedance, non-invasive method

Takala 2011Not an RCT of use of PACs - both groups had some use of PAC, the randomization was to MICO or not

Tuman 1989Not an RCT

Wilson 1999Not all patients assigned to the control group were transferred to ICU or HDU following surgery

Yu 1993Not an RCT of management with PAC compared with management without a PAC

Yu 1995Not an RCT of management with PAC compared with management without a PAC

Yu 2011Tested the intervention of blood volume measurement and both groups had PACs

Ziegler 1997Not an RCT of management with PAC compared with management without a PAC

 
Comparison 1. Combined mortality: PAC versus no PAC

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Combined mortality of all studies135686Risk Ratio (M-H, Random, 95% CI)1.01 [0.95, 1.08]

 
Comparison 2. PAC versus no PAC

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 All types mortality (general intensive care patients)52923Risk Ratio (M-H, Random, 95% CI)1.02 [0.96, 1.09]

 2 All types mortality (high-risk surgical patients)82763Risk Ratio (M-H, Random, 95% CI)0.98 [0.74, 1.29]

    2.1 All types mortality (studies of perioperative monitoring including pre-operative optimization)
52395Risk Ratio (M-H, Random, 95% CI)0.98 [0.74, 1.29]

    2.2 All types mortality (studies of perioperative monitoring)
3368Risk Ratio (M-H, Random, 95% CI)1.10 [0.14, 8.82]

 
Comparison 3. ICU length of stay PAC versus no PAC

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 ICU length of stay (general intensive care patients)42723Mean Difference (IV, Random, 95% CI)0.15 [-0.74, 1.03]

 
Comparison 4. Hospital length of stay: PAC versus no PAC

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Hospital length of stay (general intensive care patients)21689Mean Difference (IV, Random, 95% CI)-0.80 [-2.71, 1.12]

 2 Hospital length of stay (high-risk surgical patients)5503Mean Difference (IV, Random, 95% CI)0.35 [-0.05, 0.75]

 
Comparison 5. Cost of care: PAC versus no PAC

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Cost of care (hospital charges, 1000's of US dollars)2191Mean Difference (IV, Fixed, 95% CI)0.90 [-2.62, 4.42]

 
Summary of findings for the main comparison. Pulmonary artery catheter for adult patients in intensive care

Pulmonary artery catheter for adult patients in intensive care

Patient or population: Adult patients in intensive care
Settings: Intensive care unit
Intervention: Pulmonary artery catheter

OutcomesIllustrative comparative risks* (95% CI)Relative effect
(95% CI)
No of Participants
(studies)
Quality of the evidence
(GRADE)
Comments

Assumed riskCorresponding risk

ControlPulmonary artery Catheter

ICU length of stay (general intensive care patients)
Follow-up: mean 10-12 days
The mean ICU length of stay (general intensive care patients) in the intervention groups was
0.5 higher
(0.44 to 0.55 higher)
2723
(4 studies)
⊕⊕⊕⊕
high

Hospital length of stay (general intensive care patients)
Follow-up: mean 14-22 days
The mean hospital length of stay (general intensive care patients) in the intervention groups was
0.8 lower
(2.71 lower to 1.12 higher)
1689
(2 studies)
⊕⊕⊕⊕
high

Hospital length of stay (high-risk surgical patients)
Follow-up: mean 10-22 days
The mean hospital length of stay (high-risk surgical patients) in the intervention groups was
0.35 higher
(0.05 lower to 0.75 higher)
503
(5 studies)
⊕⊕⊕⊕
high

Cost of care (hospital charges, 1000s of US dollars)The mean cost of care (hospital charges, 1000's of us dollars) in the intervention groups was
0.9 higher
(2.62 lower to 4.42 higher)
191
(2 studies)
⊕⊕⊝⊝
low1

Combined mortality of all studies
Follow-up: mean 28-60 days
Study populationRR 1.01
(0.95-1.08)
5686
(13 studies)
⊕⊕⊕⊕
high

297 per 1000301 per 1000
(273 to 333)

Moderate

95 per 100097 per 1000
(85 to 110)

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; RR: Risk ratio;

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

 1 Only 2 studies reported the hospital cost out of 5, in 1990 to 91. The applicability in present situation after 20 years is questionable. The cost cannot be compared across various countries.