Pulmonary artery catheter versus pulse contour analysis: a prospective epidemiological study.
BACKGROUND
The choice of invasive systemic haemodynamic monitoring in critically ill patients remains controversial as no multicentre comparative clinical data exist. Accordingly, we sought to study and compare the features and outcomes of patients who receive haemodynamic monitoring with either the pulmonary artery catheter (PAC) or pulse contour cardiac output (PiCCO) technology.


METHODS
We conducted a prospective multicentre, multinational epidemiological study in a cohort of 331 critically ill patients who received haemodynamic monitoring by PAC or PiCCO according to physician preference in intensive care units (ICUs) of eight hospitals in four countries. We collected data on haemodynamics, demographic features, daily fluid balance, mechanical ventilation days, ICU days, hospital days, and hospital mortality. We statistically compared the two techniques.


RESULTS
Three hundred and forty-two catheters (PiCCO 192 and PAC 150) were inserted in 331 patients. On direct comparison, patients with PAC were older (68 versus 64 years of age; p = 0.0037), were given inotropic drugs more frequently (37.3% versus 13%; p < 0.0001), and had a lower cardiac index (2.6 versus 3.2 litres/minute per square meter; p < 0.0001). Mean daily fluid balance was significantly greater during PiCCO monitoring (+659 versus +350 ml/day; p = 0.017) and mechanical ventilation-free days were fewer (12 for PiCCO versus 21 for PAC; p = 0.045). However, after multiple regression analysis, we found no significant effect of monitoring technique on mean daily fluid balance, mechanical ventilation-free days, ICU-free days, or hospital mortality. A secondary multiple logistic regression analysis for hospital mortality which included mean daily fluid balance showed that positive fluid balance was a significant predictor of hospital mortality (odds ratio = 1.0002 for each ml/day; p = 0.0073).


CONCLUSIONS
On direct comparison, the use of PiCCO was associated with a greater positive fluid balance and fewer ventilator-free days. After correction for confounding factors, the choice of monitoring did not influence major outcomes, whereas a positive fluid balance was a significant independent predictor of outcome. Future studies may best be targeted at understanding the effect of pursuing different fluid balance regimens rather than monitoring techniques per se.
Uchino
Shigehiko
S
Department of Emergency and Critical Care Medicine, Saitama Medical Center, 1981 Tsujido-machi, Kamoda, Kawagoe-shi, Saitama, 350-8550, Japan.
Bellomo
Rinaldo
R
Morimatsu
Hiroshi
H
Sugihara
Makoto
M
French
Craig
C
Stephens
Dianne
D
Wendon
Julia
J
Honore
Patrick
P
Mulder
John
J
Turner
Andrew
A
D000368:Aged; D002302:Cardiac Output; D002404:Catheterization; D015331:Cohort Studies; D016638:Critical Illness; D016021:Epidemiologic Studies; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D011379:Prognosis; D011446:Prospective Studies; D011651:Pulmonary Artery; D012121:Respiration, Artificial; D013815:Thermodilution; D016896:Treatment Outcome; D014882:Water-Electrolyte Balance