title: Understanding changes in established practice: pulmonary artery catheter use in critically ill patients.
abstract: OBJECTIVE
  Multiple studies suggest that routine use of pulmonary artery catheters is not beneficial in critically ill patients. Little is known about the patterns of "uptake" of practice change that involves removal of a device previously considered standard of care, rather than adoption of a new technique or technology. Our objective was to assess recent pulmonary artery catheter use across ICUs and identify factors associated with high use.
  
  
  METHODS
  Cohort study.
  
  
  METHODS
  U.S. ICUs in Project IMPACT.
  
  
  METHODS
  Adult ICU admissions from 2001 to 2008.
  
  
  METHODS
  None.
  
  
  RESULTS
  Trends in pulmonary artery catheter use from 2001 to 2008 were assessed. For 2006-2008, we compared pulmonary artery catheter use across ICUs. We assessed characteristics of ICUs and hospitals in the top quartile for in-ICU pulmonary artery catheter placement (vs the bottom quartile) using chi-square and t tests and factors associated with in-ICU pulmonary artery catheter insertion using multilevel mixed effects logistic regression. Total pulmonary artery catheter use decreased from 10.8% of patients (2001-2003) to 6.2% (2006-2008; p < 0.001); insertion of pulmonary artery catheters in ICU decreased from 4.2% to 2.2% (p < 0.001). In 2006-2008, ICUs in the top quartile for in-ICU pulmonary artery catheter insertion (3.4-25.0% of patients) were more often surgical (54.2% vs 21.7% in the lowest quartile, p = 0.070), teaching hospitals (54.2% vs 4.3%, p = 0.001), and had surgeon leadership (40.9% vs 13.0%, p = 0.067). After multivariable regression, surgical patients (p < 0.001) and all patients in surgical ICUs (p = 0.057) were more likely to have pulmonary artery catheters placed in ICU.
  
  
  CONCLUSIONS
  Use of pulmonary artery catheters in ICU patients has declined but with significant variation across units. Removal of this technology has occurred most in nonsurgical ICUs and patients.
authors: 1Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Medical Center, Albert Einstein College of Medicine, New York, NY. 2Department of Anesthesiology, Department of Epidemiology, Columbia University, New York, NY.
authors: Hayley B
authors: HB
authors: Gershengorn
authors: Hannah
authors: H
authors: Wunsch
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D002407:Catheterization, Swan-Ganz / Q000639:trends*; D016638:Critical Illness / Q000628:therapy*; D019317:Evidence-Based Medicine; D005260:Female; D006784:Hospitals, Teaching / Q000639:trends; D006801:Humans; D007362:Intensive Care Units / Q000639:trends*; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000639:trends; D010818:Practice Patterns, Physicians' / Q000639:trends*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014481:United States
references: Lancet. 2012 Sep 22;380(9847):1066-74
references: 22998716
references: N Engl J Med. 2012 May 24;366(21):1951-3
references: 22551108
references: J Clin Monit Comput. 2012 Aug;26(4):267-78
references: 22695821
references: N Engl J Med. 2012 Oct 4;367(14):1287-96
references: 22920912
references: Lancet. 2005 Aug 6-12;366(9484):472-7
references: 16084255
references: Crit Care Med. 1995 May;23(5):860-6
references: 7736744
references: JAMA. 2003 Nov 26;290(20):2713-20
references: 14645314
references: JAMA. 2007 Jul 25;298(4):423-9
references: 17652296
references: N Engl J Med. 2003 Jan 2;348(1):5-14
references: 12510037
references: Crit Care Med. 1994 Dec;22(12):1913-8
references: 7988126
references: JAMA. 2000 May 17;283(19):2559-67
references: 10815120
references: Can J Hosp Pharm. 1995 Feb;48(1):7-15
references: 10141063
references: Am J Respir Crit Care Med. 1995 Sep;152(3):965-71
references: 7663811
references: Arch Intern Med. 2012 Sep 10;172(16):1220-6
references: 22825806
references: Neurosurgery. 2012 Oct;71(4):795-803
references: 22855028
references: Crit Care Med. 2011 Jul;39(7):1613-8
references: 21494107
references: Eur Urol. 2012 Apr;61(4):803-9
references: 22209053
references: Crit Care Med. 2012 Jul;40(7):2009-15
references: 22564962
references: Am J Respir Crit Care Med. 2006 Dec 1;174(11):1206-10
references: 16973977
references: N Engl J Med. 1984 Nov 1;311(18):1152-6
references: 6482934
references: Anesthesiology. 2010 Aug;113(2):386-94
references: 20613466
references: Am J Respir Crit Care Med. 2011 Oct 1;184(7):809-15
references: 21700910
references: N Engl J Med. 2006 May 25;354(21):2213-24
references: 16714768
references: Chest. 1987 Oct;92(4):721-7
references: 3652758
references: Crit Care Med. 2002 Dec;30(12):2765-70
references: 12483071
references: JAMA. 1996 Sep 18;276(11):889-97
references: 8782638
references: Crit Care Med. 2007 Mar;35(3):827-35
references: 17255863