The Association Between Indwelling Arterial Catheters and Mortality in Hemodynamically Stable Patients With Respiratory Failure: A Propensity Score Analysis.
BACKGROUND
Indwelling arterial catheters (IACs) are used extensively in the ICU for hemodynamic monitoring and for blood gas analysis. IAC use also poses potentially serious risks, including bloodstream infections and vascular complications. The purpose of this study was to assess whether IAC use was associated with mortality in patients who are mechanically ventilated and do not require vasopressor support.


METHODS
This study used the Multiparameter Intelligent Monitoring in Intensive Care II database, consisting of > 24,000 patients admitted to the Beth Israel Deaconess Medical Center ICU between 2001 and 2008. Patients requiring mechanical ventilation who did not require vasopressors or have a diagnosis of sepsis were identified, and the primary outcome was 28-day mortality. A model based on patient demographics, comorbidities, vital signs, and laboratory results was developed to estimate the propensity for IAC placement. Patients were then propensity matched, and McNemar test was used to evaluate the association of IAC with 28-day mortality.


RESULTS
We identified 1,776 patients who were mechanically ventilated who met inclusion criteria. There were no differences in the covariates included in the final propensity model between the IAC and non-IAC propensity-matched groups. For the matched cohort, there was no difference in 28-day mortality between the IAC group and the non-IAC group (14.7% vs 15.2%; OR, 0.96; 95% CI, 0.62-1.47).


CONCLUSIONS
In hemodynamically stable patients who are mechanically ventilated, the presence of an IAC is not associated with a difference in 28-day mortality. Validation in other datasets, as well as further analyses in other subgroups, is warranted.
Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA. Electronic address: dhsu@bidmc.harvard.edu.
Douglas J
DJ
Hsu
Laboratory of Computational Physiology, Massachusetts Institute of Technology, Cambridge, MA; Institute for Infocomm Research, Singapore.
Mengling
M
Feng
Department of Anesthesia, Mount Sinai Hospital, New York, NY.
Rishi
R
Kothari
Department of Medicine, Brigham and Women's Hospital, Boston, MA; Department of Microbiology and Immunobiology, Harvard University, Cambridge, MA.
Hufeng
H
Zhou
Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA.
Kenneth P
KP
Chen
Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA; Laboratory of Computational Physiology, Massachusetts Institute of Technology, Cambridge, MA.
Leo A
LA
Celi
D000328:Adult; D000368:Aged; D001784:Blood Gas Analysis / Q000379:methods; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D002408:Catheters, Indwelling / Q000009:adverse effects; D005260:Female; D006439:Hemodynamics; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods*; D017063:Outcome Assessment, Health Care; D057216:Propensity Score; D012121:Respiration, Artificial / Q000379:methods; D012131:Respiratory Insufficiency / Q000097:blood / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D018570:Risk Assessment; D014481:United States