Feature Articles

Understanding Changes in Established Practice

Pulmonary Artery Catheter Use in Critically III Patients*

Gershengorn, Hayley B. MD¹; Wunsch, Hannah MD, MSc²

¹Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Medical Center, Albert Einstein College of Medicine, New York, NY.

²Department of Anesthesiology, Department of Epidemiology, Columbia University, New York, NY.

* See also p. 2812.

This work was done in the Beth Israel Medical Center, Albert Einstein College of Medicine.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).

Dr. Wunsch was supported by the National Institute on Aging (K08AG038477). Dr. Gershengorn has disclosed that she does not have any potential conflicts of interest.

For information regarding this article, E-mail: [email protected]

Critical Care Medicine 41(12):p 2667-2676, December 2013. | DOI: 10.1097/CCM.0b013e318298a41e

Abstract

Objective:

Multiple studies suggest that routine use of pulmonary artery catheters is not beneficial in critically ill patients. Little is known about the patterns of “uptake” of practice change that involves removal of a device previously considered standard of care, rather than adoption of a new technique or technology. Our objective was to assess recent pulmonary artery catheter use across ICUs and identify factors associated with high use.

Design:

Cohort study.

Setting:

U.S. ICUs in Project IMPACT.

Patients:

Adult ICU admissions from 2001 to 2008.

Interventions:

None.

Measurements and Main Results:

Trends in pulmonary artery catheter use from 2001 to 2008 were assessed. For 2006–2008, we compared pulmonary artery catheter use across ICUs. We assessed characteristics of ICUs and hospitals in the top quartile for in-ICU pulmonary artery catheter placement (vs the bottom quartile) using chi-square and t tests and factors associated with in-ICU pulmonary artery catheter insertion using multilevel mixed effects logistic regression. Total pulmonary artery catheter use decreased from 10.8% of patients (2001–2003) to 6.2% (2006–2008; p < 0.001); insertion of pulmonary artery catheters in ICU decreased from 4.2% to 2.2% (p < 0.001). In 2006–2008, ICUs in the top quartile for in-ICU pulmonary artery catheter insertion (3.4–25.0% of patients) were more often surgical (54.2% vs 21.7% in the lowest quartile, p = 0.070), teaching hospitals (54.2% vs 4.3%, p = 0.001), and had surgeon leadership (40.9% vs 13.0%, p = 0.067). After multivariable regression, surgical patients (p < 0.001) and all patients in surgical ICUs (p = 0.057) were more likely to have pulmonary artery catheters placed in ICU.

Conclusions:

Use of pulmonary artery catheters in ICU patients has declined but with significant variation across units. Removal of this technology has occurred most in nonsurgical ICUs and patients.