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Central venous catheter use in low-risk coronary artery bypass grafting
R D Stewart1, T Psyhojos, S J Lahey
1Department of Anesthesia, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02215, USA.
Insights
Pulmonary artery catheter monitoring in low-risk coronary artery bypass grafting (CABG) patients was linked to increased weight gain and longer intubation times. This suggests potential for greater morbidity and resource use compared to central venous pressure monitoring.
Area of Science:
- Cardiovascular Surgery
- Critical Care Medicine
- Anesthesiology
Background:
- Investigating the impact of invasive hemodynamic monitoring in low-risk coronary artery bypass grafting (CABG).
- Comparing central venous pressure (CVP) catheter monitoring versus pulmonary artery (PA) catheter monitoring in CABG patients.
Purpose of the Study:
- To evaluate the influence of CVP catheter monitoring on the hospital course of low-risk CABG patients.
- To compare outcomes between CVP and PA catheter monitoring in this patient population.
Main Methods:
- Retrospective evaluation of 312 isolated primary CABG procedures (April-October 1996).
- Identified 194 patients meeting CVP catheter use criteria.
- Compared 133 patients with CVP monitoring to 61 patients with PA monitoring.
Main Results:
- In-hospital mortality was similar between groups.
- Pulmonary artery catheter group showed trends toward increased complications, longer intensive care unit (ICU) stays, and higher hospital charges.
- Significantly greater fluid volume infused, 24-hour weight gain, and intubation time were observed in the PA catheter group.
Conclusions:
- Pulmonary artery catheter use in low-risk CABG patients was associated with increased fluid retention and prolonged mechanical ventilation.
- PA catheter monitoring may be linked to higher morbidity and increased utilization of hospital resources.
- CVP catheter monitoring may be a preferable alternative for hemodynamic assessment in select low-risk CABG patients.
Background:
To assess the impact of central venous pressure catheter monitoring in low-risk coronary artery bypass grafting (CABG), we compared the hospital course of patients undergoing CABG with central venous pressure catheter monitoring with that of similar patients undergoing CABG with pulmonary artery catheter monitoring.
Methods:
All isolated primary CABG procedures (n = 312) performed between April 22 and October 31, 1996, were evaluated, and 194 patients meeting six central venous pressure catheter use criteria were identified. Of these 194 patients, 133 (68%) underwent CABG with central venous pressure catheter monitoring, and 61 (32%) had pulmonary artery catheter monitoring owing to surgeon or anesthesiologist preference.
Results:
In-hospital mortality was similar. A trend toward increased overall complications was seen in the pulmonary artery catheter group. The total volume infused in the first 12 hours, the 24-hour weight gain, and the intubation time were significantly greater in the pulmonary artery catheter group. Increases in intensive care unit length of stay and in total hospital charges trended toward statistical significance in the pulmonary artery catheter group.
Conclusions:
Pulmonary artery catheter use in low-risk patients undergoing CABG was associated with greater weight gain and longer intubation time and may be associated with increased morbidity and utilization of hospital resources.