Do Arterial Catheters Improve ICU Patient Care?

Hayley Gershengorn MD Assistant Professor, Department of Medicine (Critical Care) Assistant Professor, The Saul R. Korey Department of Neurology Albert Einstein College of Medicine Bronx, NY 10461MedicalResearch.com Interview with:
Hayley Gershengorn MD
Assistant Professor, Department of Medicine (Critical Care)
Assistant Professor, The Saul R. Korey Department of Neurology
Albert Einstein College of Medicine
Bronx, NY 10461

Medical Research:  What are the main findings of the study?

Dr. Gershengorn: Using a large national database, we found there to be no association between the use of arterial catheters and mortality in mechanically ventilated medical intensive care unit patients. Similarly, we found no beneficial association between arterial catheters and mortality in any of the eight other critically ill subgroups evaluated.

Medical Research:  Were any of the findings unexpected?

Dr. Gershengorn: Arterial catheters are commonly used in intensive care unit patients to monitor blood pressure and facilitate arterial blood sampling. Clinicians utilize these catheters because they presume them to confer benefit to their patients. Our findings are the first to call this assumption into question.

Medical Research:  What should clinicians and patients take away from your report?
Dr. Gershengorn: Monitoring devices such as arterial catheters are not without cost—both in terms of potential complications patients might suffer from them and financial costs. History has shown critical care practitioners that the prevalent use of certain intravascular monitoring devices (specifically, the pulmonary artery catheter) may not be in our patients’ best interests. In fact, it was a propensity-matched analysis similar to ours by Connors et al.1 which ignited a series of prospective randomized controlled trials all finding no benefit to use of the pulmonary artery catheter in intensive care unit patients.2-5 Given our study design, we cannot demonstrate a true causal relationship between arterial catheters and outcomes.   As such, we view it as hypothesis generating—just as Connors et al.’s work was for the pulmonary artery catheter. We hope it will spur prospective study of this topic.

Medical Research:  What recommendations do you have for future research as a result of this study?

Dr. Gershengorn: As alluded to above, we believe our study has created the needed equipoise to compel a prospective randomized controlled trial to evaluate the causal relationship between arterial catheter use and outcomes (e.g., mortality, morbidity, cost) in intensive care unit patients. Given the prevalent use of these catheters,6 the potential complications associated with them, and the financial costs of inserting and maintaining them, we believe such a trial is greatly needed.

References

  1. Connors AF, Speroff T, Dawson NV, et al. The effectiveness of right heart catheterization in the initial care of critically ill patients. SUPPORT Investigators. JAMA. 1996;276(11):889-897.
  2. Sandham JD, Hull RD, Brant RF, et al. A randomized, controlled trial of the use of pulmonary-artery catheters in high-risk surgical patients. N Engl J Med. 2003;348(1):5-14.
  3. Richard C, Warszawski J, Anguel N, et al. Early use of the pulmonary artery catheter and outcomes in patients with shock and acute respiratory distress syndrome: a randomized controlled trial. JAMA. 2003;290(20):2713-2720.
  4. Harvey S, Harrison DA, Singer M, et al. Assessment of the clinical effectiveness of pulmonary artery catheters in management of patients in intensive care (PAC-Man): a randomised controlled trial. Lancet. 2005;366(9484):472-477.
  5. Wheeler AP, Bernard GR, Thompson BT, et al. Pulmonary-artery versus central venous catheter to guide treatment of acute lung injury. N Engl J Med. 2006;354(21):2213-2224.
  6. Gershengorn HB, Garland A, Kramer A, Scales DC, Rubenfeld G, Wunsch H. Variation of Arterial and Central Venous Catheter Use in United States Intensive Care Units. Anesthesiology. 2014;120(3):650-664.

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