Association of pulmonary artery catheter use with in-hospital mortality.
OBJECTIVE
To determine the association of pulmonary artery catheter (PAC) use with in-hospital mortality.


METHODS
Prospective, observational study.


METHODS
The medical intensive care units (MICU) of two teaching hospitals.


METHODS
The study included 751 adults who were admitted to the MICU, excluding those who stayed for <24 hrs. Demographics and the worst Acute Physiology and Chronic Health Evaluation (APACHE) II score within the first 24 hrs of MICU admission were obtained. Daily logistic organ dysfunction system (LODS) scores were calculated. The associations of in-hospital mortality with the admission source, admission disease category, APACHE II scores, the worst LODS scores, mechanical ventilation, and PAC use were determined using chi-square, Mann-Whitney U, and multiple logistic regression analysis tests. p Values < 0.05 were considered significant.


RESULTS
Mean patient age was 52.6 +/- 17.1 yrs; 425 (57%) were male; 464 (62%) were African-American, 275 (37%) Caucasian, 6 (1%) Asian, and 6 (1%) Hispanic. PAC was used in 119/751 (16%). The median APACHE II and worst LODS scores were 19 and 4, respectively. The in-hospital mortality rate was 159/751 (21%). The median APACHE II score for survivors was 17.5, compared with 28.0 for nonsurvivors (p <.0001). The worst median LODS score was 4 for survivors, compared with 11 for nonsurvivors (p <.0001). Sixty-four (54%) of the 119 patients with PAC died, compared with 95 (15%) of the 632 without PAC (p <.0001). Multiple logistic regression analysis showed that higher APACHE II-predicted mortality rate (p =.0088) and worst daily LODS score (p <.0001) were associated with increased mortality. The admission source, admission disease category, PAC use, and mechanical ventilation were not associated with in-hospital mortality.


CONCLUSIONS
This study could not detect an association between PAC use and mortality. The APACHE II-predicted mortality rate and the development of multiple organ dysfunction were the main determinants of poor outcome in critically ill patients admitted to MICU.
Afessa
B
B
Division of Pulmonary and Critical Care, Department of Medicine, University of Florida Health Science Center, Jacksonville, FL, USA. afessa.bekele@mayo.edu
Spencer
S
S
Khan
W
W
LaGatta
M
M
Bridges
L
L
Freire
A X
AX
D018806:APACHE; D002407:Catheterization, Swan-Ganz / Q000009:adverse effects*; D016009:Chi-Square Distribution; D016638:Critical Illness; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure; D011446:Prospective Studies; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D012122:Ventilators, Mechanical