title: Swan-Ganz catheter use in trauma patients can be reduced without negatively affecting outcomes.
abstract: OBJECTIVE
  The use of pulmonary artery catheter (PAC) is controversial. The purpose of this study was to document the changing pattern of PAC use and to determine its effect on outcome.
  
  
  METHODS
  The use of PAC was analyzed in patients ≥16 years old admitted to the surgical intensive care unit (SICU) over a 9-year period starting in 2000. Patients with SICU length of stay exceeding 30 days were excluded. For the evaluation of PAC's effect on outcome, PAC and no-PAC patients were matched utilizing propensity scores.
  
  
  RESULTS
  During the 9-year study period, a total of 5,192 trauma patients were admitted to the SICU. Of these, 426 (8.2%) were <16 years old, and 174 (3.4%) had a SICU length of stay that exceeded 30 days. For the remaining 4,592 patients, the mean ± SD age was 39.5 ± 18.8 years, and the mean ISS was 19.9 ± 12.4. PAC was utilized in 19.5% (n = 896) of all the patients admitted to the SICU. The trend for PAC use decreased significantly over the years (P value for trend <0.001), from 38.6% in the year 2000 to 4.2% in the year 2008. This decrease was noted in all age and injury severity groups of patients. The overall mortality, however, remained at the same levels (P value for trend = 0.111). Patients managed with a PAC were significantly older, more severely injured, more frequently injured by a blunt mechanism, and were admitted more often in a hypotensive or comatose status. In the early part of the study, the PAC was utilized on the first day and for 4.1 days on average. In the later part of the study, however, the PAC was used on the second day and for a shorter period of time (3 days on average, P < 0.001). In the matched study population, patients in the PAC group had almost twofold higher odds for death, when compared to the no-PAC group [34.2% vs. 22.5%, Odds Ratio (95% CI): 1.78 (1.42, 2.26), P < 0.001]. Patients younger than 50 years of age who had an ISS ≥16 had worse outcome when managed with a PAC, whereas patients aged 30-69 years with an ISS <16 had a higher survival. The overall complication rate was fivefold higher in patients receiving a PAC [46.3% vs. 14.2%, Odds Ratio (95% CI): 5.22 (4.04, 6.74), P < 0.001].
  
  
  CONCLUSIONS
  The use of PAC has decreased almost 10-fold over the last decade at our institution. The PAC is being used later during the ICU course and for a shorter period of time. In a matched population, the use of PAC is associated with a significantly higher mortality and complication rate, but the reason for this association remains uncertain. The use of PAC is invasive and is associated with known complications and financial costs. While the use of PAC maybe useful in a select population, routine and widespread use of the PAC should be avoided.
authors: Division of Acute Care Surgery (Trauma, Emergency Surgery and Surgical Critical Care), Los Angeles County and University of Southern California Medical Center, Los Angeles, CA, USA.
authors: Galinos
authors: G
authors: Barmparas
authors: Kenji
authors: K
authors: Inaba
authors: Chrysanthos
authors: C
authors: Georgiou
authors: Pantelis
authors: P
authors: Hadjizacharia
authors: Linda S
authors: LS
authors: Chan
authors: Demetrios
authors: D
authors: Demetriades
authors: Randall
authors: R
authors: Friese
authors: Peter
authors: P
authors: Rhee
references: Ann Surg. 2000 Sep;232(3):409-18
references: 10973391
references: J Trauma. 2002 Jun;52(6):1141-6
references: 12045644
references: Ann Surg. 1991 Sep;214(3):289-97; discussion 298-9
references: 1929610
references: J Vasc Surg. 1998 Feb;27(2):203-11; discussion 211-2
references: 9510275
references: Lancet. 2005 Aug 6-12;366(9484):472-7
references: 16084255
references: J Vasc Surg. 1990 Dec;12(6):754-60
references: 2243411
references: JAMA. 2003 Nov 26;290(20):2713-20
references: 14645314
references: J Trauma. 1995 May;38(5):780-7
references: 7760409
references: Eur J Vasc Endovasc Surg. 2002 May;23(5):445-51
references: 12027474
references: Ann Surg. 1997 Sep;226(3):229-36; discussion 236-7
references: 9339929
references: JAMA. 2005 Oct 5;294(13):1664-70
references: 16204666
references: Health Care Financ Rev. 1994 Summer;15(4):91-103
references: 10138487
references: JAMA. 2005 Oct 5;294(13):1625-33
references: 16204662
references: JAMA. 2007 Jul 25;298(4):423-9
references: 17652296
references: Chest. 1988 Dec;94(6):1176-86
references: 3191758
references: N Engl J Med. 2003 Jan 2;348(1):5-14
references: 12510037
references: Crit Care Med. 2006 Jun;34(6):1597-601
references: 16607232
references: J Intensive Care Med. 1991 Mar-Apr;6(2):91-5
references: 10147952
references: J Trauma. 1985 Apr;25(4):309-16
references: 3989888
references: Intensive Care Med. 2002 Mar;28(3):256-64
references: 11904653