Variability in interventions with pulmonary artery catheter data.
OBJECTIVE
To determine if intensivists given PAC data from critically ill patients make uniform management choices.


METHODS
Cross-sectional survey of board-certified intensivists.


METHODS
Medical intensive care unit.


METHODS
Board-certified intensivists who are members of the American College of Chest Physicians and Society of Critical Care Medicine.


METHODS
A survey questionnaire containing three medical intensive care clinical vignettes was mailed to critical care physicians. Each vignette contained PAC data and one-half of the surveys contained echocardiographic (Echo) information. Every respondent was asked to select one of six interventions for each vignette.


METHODS
There were 126 evaluable surveys returned. In vignette 1 an intervention (none of the above) was selected by more than 50% of respondents. In vignettes 2 and 3, the most frequent selection was chosen only 44 and 37% of the times, respectively. There was a significant difference in the distribution of management choices between te Echo and the non-Echo subgroups.


CONCLUSIONS
There is a significant heterogeneity in selecting an intervention based on PAC data among intensivists. The presence of Echo information may change the intervention selected but does not reduce heterogeneity. Any randomized trial evaluating efficacy of PAC's will have to have strict treatment protocols.
Jain
Manu
M
Division of Pulmonary and Critical Care Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA. m-jain@northwestern.edu
Canham
Michelle
M
Upadhyay
Daya
D
Corbridge
Thomas
T
D001291:Attitude of Health Personnel; D002316:Cardiotonic Agents / Q000627:therapeutic use; D002407:Catheterization, Swan-Ganz; D003422:Critical Care / Q000379:methods* / Q000706:statistics & numerical data; D016638:Critical Illness / Q000628:therapy; D003430:Cross-Sectional Studies; D003625:Data Collection / Q000379:methods; D003657:Decision Making; D004232:Diuretics / Q000627:therapeutic use; D004280:Dobutamine / Q000627:therapeutic use; D004298:Dopamine / Q000627:therapeutic use; D017548:Echocardiography, Transesophageal; D005665:Furosemide / Q000627:therapeutic use; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007087:Illinois; D008505:Medical Staff, Hospital / Q000523:psychology; D009599:Nitroprusside / Q000627:therapeutic use; D018579:Patient Selection; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011365:Professional Practice Location; D011795:Surveys and Questionnaires; D014665:Vasodilator Agents / Q000627:therapeutic use
D002316:Cardiotonic Agents; D004232:Diuretics; D014665:Vasodilator Agents; D009599:Nitroprusside; D004280:Dobutamine; D005665:Furosemide; D004298:Dopamine