Dataset Information

Pulmonary Artery Catheter Use and Mortality in the Cardiac Intensive Care Unit.

ABSTRACT:

Background

The appropriate use of pulmonary artery catheters (PACs) in critically ill cardiac patients remains debated.

Objectives

The authors aimed to characterize the current use of PACs in cardiac intensive care units (CICUs) with attention to patient-level and institutional factors influencing their application and explore the association with in-hospital mortality.

Methods

The Critical Care Cardiology Trials Network is a multicenter network of CICUs in North America. Between 2017 and 2021, participating centers contributed annual 2-month snapshots of consecutive CICU admissions. Admission diagnoses, clinical and demographic data, use of PACs, and in-hospital mortality were captured.

Results

Among 13,618 admissions at 34 sites, 3,827 were diagnosed with shock, with 2,583 of cardiogenic etiology. The use of mechanical circulatory support and heart failure were the patient-level factors most strongly associated with a greater likelihood of the use of a PAC (OR: 5.99 [95% CI: 5.15-6.98]; P < 0.001 and OR: 3.33 [95% CI: 2.91-3.81]; P < 0.001, respectively). The proportion of shock admissions with a PAC varied significantly by study center ranging from 8% to 73%. In analyses adjusted for factors associated with their placement, PAC use was associated with lower mortality in all shock patients admitted to a CICU (OR: 0.79 [95% CI: 0.66-0.96]; P = 0.017).

Conclusions

There is wide variation in the use of PACs that is not fully explained by patient level-factors and appears driven in part by institutional tendency. PAC use was associated with higher survival in cardiac patients with shock presenting to CICUs. Randomized trials are needed to guide the appropriate use of PACs in cardiac critical care.

SUBMITTER: Kadosh BS

PROVIDER: S-EPMC10527413 | biostudies-literature | 2023 Aug

REPOSITORIES: biostudies-literature

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Publications

Pulmonary Artery Catheter Use and Mortality in the Cardiac Intensive Care Unit.

Kadosh Bernard S BS Berg David D DD Bohula Erin A EA Park Jeong-Gun JG Baird-Zars Vivian M VM Alviar Carlos C Alzate James J Barnett Christopher F CF Barsness Gregory W GW Burke James J Chaudhry Sunit-Preet SP Daniels Lori B LB DeFilippis Andrew A Delicce Anthony A Fordyce Christopher B CB Ghafghazi Shahab S Gidwani Umesh U Goldfarb Michael M Katz Jason N JN Keeley Ellen C EC Kenigsberg Benjamin B Kontos Michael C MC Lawler Patrick R PR Leibner Evan E Menon Venu V Metkus Thomas S TS Miller P Elliott PE O'Brien Connor G CG Papolos Alexander I AI Prasad Rajnish R Shah Kevin S KS Sinha Shashank S SS Snell R Jeffrey RJ So Derek D Solomon Michael A MA Ternus Bradley W BW Teuteberg Jeffrey J JJ Toole Joseph J van Diepen Sean S Morrow David A DA Roswell Robert O RO

JACC. Heart failure 20230614 8 Pt 1

<h4>Background</h4>The appropriate use of pulmonary artery catheters (PACs) in critically ill cardiac patients remains debated.<h4>Objectives</h4>The authors aimed to characterize the current use of PACs in cardiac intensive care units (CICUs) with attention to patient-level and institutional factors influencing their application and explore the association with in-hospital mortality.<h4>Methods</h4>The Critical Care Cardiology Trials Network is a multicenter network of CICUs in North America. B ...[more]

PMID: 37318422

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Project description:Background Impaired right ventricular (RV) pulmonary artery coupling has been associated with higher mortality in patients with chronic heart disease, but few studies have examined this metric in critically ill patients. We sought to evaluate the association between RV pulmonary artery coupling, defined by the ratio of tricuspid annular peak systolic tissue Doppler velocity (TASV)/estimated RV systolic pressure (RVSP), and mortality in cardiac intensive care unit patients. Methods and Results Using a database of unique cardiac intensive care unit admissions from 2007 to 2018, we included patients with TASV/RVSP ratio measured within 1 day of hospitalization. Hospital mortality was analyzed using multivariable logistic regression, and 1-year mortality was analyzed using multivariable Cox proportional-hazards analysis. We included 4259 patients with a mean age of 69±15 years (40.1% women). Admission diagnoses included acute coronary syndrome in 56%, heart failure in 52%, respiratory failure in 24%, and cardiogenic shock in 12%. The mean TASV/RVSP ratio was 0.31±0.14, and in-hospital mortality occurred in 7% of patients. Higher TASV/RVSP ratio was associated with lower in-hospital mortality (adjusted unit odds ratio, 0.68 per each 0.1-unit higher ratio; 95% CI, 0.58-0.79; P<0.001) and lower 1-year mortality among hospital survivors (adjusted unit hazard ratio, 0.83 per each 0.1-unit higher ratio; 95% CI, 0.77-0.90; P<0.001). Stepwise decreases in hospital and 1-year mortality were observed in each higher TASV/RVSP quintile. The TASV/RVSP ratio remained associated with mortality after adjusting for left ventricular systolic and diastolic function. Conclusions A low TASV/RVSP ratio is associated with increased short-term and long-term mortality among cardiac intensive care unit patients, emphasizing importance of impaired RV pulmonary artery coupling as a determinant of poor prognosis. Further study is required to determine whether interventions to optimize RV pulmonary artery coupling can improve outcomes.

Project description:BackgroundIt has been 50 years since the pulmonary artery catheter was introduced, but the actual use of pulmonary artery catheters in recent years is unknown. Some randomized controlled trials have reported no causality with mortality, but some observational studies have been published showing an association with mortality for patients with cardiogenic shock, and the association with a pulmonary artery catheter and mortality is unknown. The aim of this study was to investigate the utilization of pulmonary artery catheters (PACs) in the intensive care unit (ICU) and to examine their association with mortality, taking into account differences between hospitals.MethodsThis is a retrospective analysis using the Japanese Intensive care PAtient Database, a multicenter, prospective, observational registry in Japanese ICUs. We included patients aged 16 years or older who were admitted to the ICU for reasons other than procedures. We excluded patients who were discharged within 24 h or had missing values. We compared the prognosis of patients with and without PAC. The primary outcome was hospital mortality. We performed propensity score analysis to adjust for baseline characteristics and hospital characteristics.ResultsAmong 184,705 patients in this registry from April 2015 to December 2020, 59,922 patients were included in the analysis. Most patients (94.0%) with a PAC in place had cardiovascular disease. There was a wide variation in the frequency of PAC use between hospitals, from 0 to 60.3% (median 14.4%, interquartile range 2.2-28.6%). Hospital mortality was not significantly different between the PAC use group and the non-PAC use group in patients after adjustment for propensity score analysis (3.9% vs 4.3%; difference, - 0.4%; 95% CI - 1.1 to 0.3; p = 0.32). Among patients with cardiac disease, those with post-open-heart surgery and those in shock, hospital mortality was also not significantly different between the two groups (3.4% vs 3.7%, p = 0.45, 1.7% vs 1.7%, p = 0.93, 4.8% vs 4.9%, p = 0.87).ConclusionsThe frequency of PAC use varied among hospitals. PAC use for ICU patients was not associated with lower hospital mortality after adjusting for differences between hospitals.

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Dataset Information

Pulmonary Artery Catheter Use and Mortality in the Cardiac Intensive Care Unit.

Background

Objectives

Methods

Results

Conclusions

Publications

Pulmonary Artery Catheter Use and Mortality in the Cardiac Intensive Care Unit.

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