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Published on: June 12, 2021
Association between arterial catheter use and hospital mortality in intensive care units
Hayley B Gershengorn1, Hannah Wunsch2, Damon C Scales3
1Division of Critical Care Medicine, Montefiore Medical Center, Bronx, New York.
Insights
Arterial catheter use in intensive care units (ICUs) was not associated with hospital mortality in mechanically ventilated patients. Further research is needed to confirm the clinical effectiveness and safety of these devices.
Area of Science:
- Critical Care Medicine
- Clinical Effectiveness Research
- Patient Safety
Background:
- Arterial catheters are frequently used in intensive care units (ICUs).
- The clinical effectiveness and adverse events associated with arterial catheter use have not been formally evaluated in clinical studies.
- Understanding the impact of arterial catheters on patient outcomes is crucial for optimizing ICU care.
Purpose of the Study:
- To determine the association between arterial catheter use and hospital mortality in intensive care unit (ICU) patients.
- To evaluate the impact of arterial catheters on mortality in specific ICU patient cohorts.
Main Methods:
- Propensity-matched cohort analysis of the Project IMPACT database (2001-2008).
- Included 139 US ICUs with adult patients (≥18 years).
- Primary analysis focused on medical patients requiring mechanical ventilation, with 9 secondary cohorts and sensitivity analyses using various statistical methods.
Main Results:
- No association was found between arterial catheter use and hospital mortality in the primary cohort of mechanically ventilated medical patients (OR, 0.98; 95% CI, 0.93-1.03).
- This finding was consistent across 4 sensitivity analyses.
- An increased odds of death was observed in the cohort of patients receiving vasopressors (OR, 1.08; 95% CI, 1.02-1.14).
Conclusions:
- Arterial catheters were not associated with improved hospital mortality in medical ICU patients requiring mechanical ventilation.
- The study highlights the need for randomized clinical trials to further evaluate the usefulness of arterial catheters.
- Considering potential harms and costs, evidence-based guidelines for arterial catheter use are warranted.
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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