Hayley B Gershengorn1, Hannah Wunsch2, Damon C Scales3, Ryan Zarychanski4, Gordon Rubenfeld5, Allan Garland6. 1. Division of Critical Care Medicine, Montefiore Medical Center, Bronx, New York. 2. Department of Anesthesiology, Columbia University, New York, New York3Department of Epidemiology, Columbia University, New York, New York. 3. Interdepartmental Division of Critical Care, University of Toronto, Toronto, Ontario, Canada. 4. Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada6Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada. 5. Department of Medicine, University of Toronto School of Medicine, Toronto, Ontario, Canada8Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. 6. Department of Medicine and Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
Abstract
IMPORTANCE: Arterial catheters are used frequently in intensive care units (ICUs). Clinical effectiveness and adverse events associated with the use of the catheters have not been formally evaluated in clinical studies. OBJECTIVE: To determine whether an association exists between arterial catheter use and hospital mortality in ICU patients. DESIGN, SETTING, AND PARTICIPANTS: Propensity-matched cohort analysis of data in the Project IMPACT database, from 2001 to 2008. A total of 139 ICUs in the United States were included. Participants were ICU patients 18 years or older. EXPOSURE: Arterial catheter use. MAIN OUTCOMES AND MEASURES: Our main outcome was hospital mortality. We assessed a primary cohort of medical patients requiring mechanical ventilation and 9 secondary cohorts. We used propensity score-matched pairs as the primary analytic strategy. Sensitivity analyses included 4 alternative methods of comparison in the primary cohort: multivariate modeling without propensity adjustment, mixed-effects multivariate logistic regression without propensity adjustment, multivariate modeling with propensity adjustment, and stratification based on propensity quintiles. RESULTS: Our primary cohort consisted of 60 975 patients; 24 126 of these patients (39.6%) had an arterial catheter in place during their ICU stay, and analyses were based on 13 603 propensity score-matched pairs. We found no association between arterial catheter use and hospital mortality in medical patients requiring mechanical ventilation in the primary analysis (odds ratio [OR], 0.98; 95% CI, 0.93-1.03; P = .40) or the 4 sensitivity analyses (P ≥ .58 for all). In 8 of 9 secondary cohorts we were unable to detect an association between arterial catheter use and hospital mortality. In the cohort of patients receiving vasopressors, arterial catheter use was associated with an increased odds of death (OR, 1.08; 95% CI, 1.02-1.14; P = .008). CONCLUSIONS AND RELEVANCE: In this propensity-matched cohort analysis, arterial catheters were not associated with improvements in hospital mortality in medical ICU patients requiring mechanical ventilation. Given the costs and potential harms associated with invasive catheters, randomized clinical trials are needed to further evaluate the usefulness of these frequently used devices.
IMPORTANCE: Arterial catheters are used frequently in intensive care units (ICUs). Clinical effectiveness and adverse events associated with the use of the catheters have not been formally evaluated in clinical studies. OBJECTIVE: To determine whether an association exists between arterial catheter use and hospital mortality in ICU patients. DESIGN, SETTING, AND PARTICIPANTS: Propensity-matched cohort analysis of data in the Project IMPACT database, from 2001 to 2008. A total of 139 ICUs in the United States were included. Participants were ICU patients 18 years or older. EXPOSURE: Arterial catheter use. MAIN OUTCOMES AND MEASURES: Our main outcome was hospital mortality. We assessed a primary cohort of medical patients requiring mechanical ventilation and 9 secondary cohorts. We used propensity score-matched pairs as the primary analytic strategy. Sensitivity analyses included 4 alternative methods of comparison in the primary cohort: multivariate modeling without propensity adjustment, mixed-effects multivariate logistic regression without propensity adjustment, multivariate modeling with propensity adjustment, and stratification based on propensity quintiles. RESULTS: Our primary cohort consisted of 60 975 patients; 24 126 of these patients (39.6%) had an arterial catheter in place during their ICU stay, and analyses were based on 13 603 propensity score-matched pairs. We found no association between arterial catheter use and hospital mortality in medical patients requiring mechanical ventilation in the primary analysis (odds ratio [OR], 0.98; 95% CI, 0.93-1.03; P = .40) or the 4 sensitivity analyses (P ≥ .58 for all). In 8 of 9 secondary cohorts we were unable to detect an association between arterial catheter use and hospital mortality. In the cohort of patients receiving vasopressors, arterial catheter use was associated with an increased odds of death (OR, 1.08; 95% CI, 1.02-1.14; P = .008). CONCLUSIONS AND RELEVANCE: In this propensity-matched cohort analysis, arterial catheters were not associated with improvements in hospital mortality in medical ICU patients requiring mechanical ventilation. Given the costs and potential harms associated with invasive catheters, randomized clinical trials are needed to further evaluate the usefulness of these frequently used devices.
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