title: Digital output volumetric pulmonary artery catheters eliminate interoperator interpretation variability and improve consistency of treatment decisions.
abstract: BACKGROUND
  The pulmonary artery catheter (PAC) has been fraught with controversy over issues of safety and impact on outcomes variables for many years. Multiple attempts to quantify the utility of this diagnostic instrument have failed to resolve the matter. Previous investigations have focused on either quantifying inter-rater variability of waveform output interpretation from PACs or on clinical outcomes when PACs are used in care. We tested the hypothesis that the true link between a diagnostic tool and outcomes is treatment selection, and an instrument that minimizes or eliminates the need for data interpretation would also minimize the variability of treatment selections.
  
  
  METHODS
  We performed a prospective, single institutional, single blinded survey study.
  
  
  RESULTS
  The inter-rater variability of waveform interpretation among all raters was notable (p < 0.01); for continuous end diastolic volume index interpretation, there was no notable inter-rater variability (p=1.0). Inter-rater variability of treatment selections based on waveform interpretation was notable for all raters (p < 0.01). Continuous end diastolic volume index data presentation of hemodynamic status did not result in notable inter-rater variability in treatment selections (p=0.10). Treatment choices based on continuous end diastolic volume index among raters with 5 or more years of experience are not different from clinical practice guideline-directed choices (p > 0.05), independent of patient ventilator status.
  
  
  CONCLUSIONS
  Digital output volumetric PACs eliminate inter-rater variability of data interpretation, decrease inter-rater variability of data-driven treatment selections, and improve rater agreement with clinical practice guidelines when compared with traditional waveform output PACs.
authors.affiliation: Department of Surgery, Division of Traumatology & Surgical Critical Care, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA.
authors.forename: Vicente H
authors.initials: VH
authors.lastname: Gracias
authors.forename: Annamarie D
authors.initials: AD
authors.lastname: Horan
authors.forename: Patrick K
authors.initials: PK
authors.lastname: Kim
authors.forename: Neil K
authors.initials: NK
authors.lastname: Puri
authors.forename: Rajan
authors.initials: R
authors.lastname: Gupta
authors.forename: John J
authors.initials: JJ
authors.lastname: Gallagher
authors.forename: Corinna P
authors.initials: CP
authors.lastname: Sicoutris
authors.forename: Mario
authors.initials: M
authors.lastname: Grasso
authors.forename: C William
authors.initials: CW
authors.lastname: Hanson
authors.forename: C William
authors.initials: CW
authors.lastname: Schwab
mesh_terms: D002302:Cardiac Output / Q000502:physiology*; D002407:Catheterization, Swan-Ganz / Q000295:instrumentation* / Q000706:statistics & numerical data; D002755:Choice Behavior; D003422:Critical Care; D003657:Decision Making; D019983:Guideline Adherence; D006801:Humans; D015588:Observer Variation; D010347:Patient Care Planning; D011446:Prospective Studies; D011669:Pulmonary Wedge Pressure / Q000502:physiology; D012119:Respiration; D012121:Respiration, Artificial; D012815:Signal Processing, Computer-Assisted; D016037:Single-Blind Method; D000078329:Workforce