Increased risk associated with pulmonary artery catheterization in the medical intensive care unit

To determine whether the frequency of use of a pulmonary artery catheter (PAC) was declining over a 5-year period in a medical intensive care unit (ICU), and to assess whether mortality was higher in patients in whom a PAC was used on the day of ICU admission compared with matched controls.

Observational, retrospective, matched-set study using prospectively collected Acute Pysiology, Age and Chronic Health Evaluation (APACHE) III data during a 5-year period, from 1995 to 2000, at a 15-bed medical ICU in an academic referral center. A total of 360 patients, 202 men and 158 women, in whom a PAC was placed on the first ICU day, were compared with 690 controls without a PAC, matched by primary diagnosis group and APACHE III-predicted hospital mortality.

A PAC was used during the first day in 7.7% of ICU admissions (yearly range, 5.7% to 9.1%) and did not change significantly during the study period. A total of 187 study patients (27.0%) without a PAC and 132 (36.7%) with a PAC died during their hospital stay. PAC use was a significant risk factor for hospital death from a univariate analysis (odds ratio = 1.5; 95% confidence interval (CI), 1.1-2.1; P =.006). From multivariate analysis, the use of a pulmonary artery catheter was a significant risk factor for hospital death after adjusting for age, date of ICU admission, and predicted hospital mortality (odds ratio = 1.5; 95% CI; 1.1-2.0; P =.016).

PAC use on the day of admission to a medical ICU was associated with an increased risk for hospital death.