 |
|
Early Use of the Pulmonary Artery Catheter and Outcomes in Patients With Shock and Acute Respiratory Distress Syndrome
A Randomized Controlled Trial
Christian Richard, MD;
Josiane Warszawski, MD, PhD;
Nadia Anguel, MD;
Nicolas Deye, MD;
Alain Combes, MD;
Didier Barnoud, MD;
Thierry Boulain, MD;
Yannick Lefort, MD;
Muriel Fartoukh, MD;
Frederic Baud, MD, PhD;
Alexandre Boyer, MD;
Laurent Brochard, MD, PhD;
Jean-Louis Teboul, MD, PhD; for the French Pulmonary Artery Catheter Study Group
JAMA. 2003;290:2713-2720.
Context Many physicians believe that the pulmonary artery catheter (PAC) is useful for the diagnosis and treatment of cardiopulmonary disturbances; however, observational studies suggest that its use may be harmful.
Objective To determine the effects on outcome of the early use of a PAC in patients with shock mainly of septic origin, acute respiratory distress syndrome (ARDS), or both.
Design, Setting, and Patients A multicenter randomized controlled study of 676 patients aged 18 years or older who fulfilled the standard criteria for shock, ARDS, or both conducted in 36 intensive care units in France from January 30, 1999, to June 29, 2001.
Intervention Patients were randomly assigned to either receive a PAC (n = 335) or not (n = 341). The treatment was left to the discretion of each individual physician.
Main Outcome Measures The primary end point was mortality at 28 days. The principal secondary end points were day 14 and 90 mortality; day 14 organ system, renal support, and vasoactive agents–free days; hospital, intensive care unit, and mechanical ventilation–free days at day 28.
Results The 2 groups were similar at baseline. There were no significant differences in mortality with or without the PAC at day 14: 49.9% vs 51.3% (mortality relative risk [RR], 0.97; 95% confidence interval [CI], 0.84-1.13; P = .70); day 28: 59.4% vs 61.0% (RR, 0.97; 95% CI, 0.86-1.10; P = .67); or day 90: 70.7% vs 72.0% (RR, 0.98; 95% CI, 0.89-1.08; P = .71). At day 14, the mean (SD) number of days free of organ system failures with or without the PAC (2.3 [3.6] vs 2.4 [3.5]), renal support (7.4 [6.0] vs 7.5 [5.9]), and vasoactive agents (3.8 [4.8] vs 3.9 [4.9]) did not differ. At day 28, mean (SD) days in hospital with or without the PAC (0.9 [3.6] vs 0.9 [3.3]), in the intensive care unit (3.4 [6.8] vs 3.3 [6.9]), or mechanical ventilation use (5.2 [8.5] vs 5.0 [8.5]) did not differ.
Conclusion Clinical management involving the early use of a PAC in patients with shock, ARDS, or both did not significantly affect mortality and morbidity.
Author Affiliations: Service de Réanimation Médicale (Drs Richard, Anguel, and Teboul) and Service de Santé Publique et Epidémiologie (Dr Warszawski), Hôpital de Bicêtre, Assistance Publique, Hôpitaux de Paris, Université Paris XI, Le Kremlin Bicêtre; Service de Réanimation Médicale, Hôpital Européen Georges Pompidou (Dr Deye), Service de Réanimation Médicale, Groupe Hospitalier Pitié-Salpétrière (Dr Combes), and Service de Pneumologie et Réanimation, Groupe Hospitalier Pitié-Salpétrière (Dr Lefort), Assistance Publique, Hôpitaux de Paris, Université Paris VI, Paris; Service de Réanimation Médicale, Centre Hospitalo-Universitaire A. Michallon, Grenoble (Dr Barnoud); Service de Réanimation, Centre Hospitalier Régional Orléans-La Source, Orléans (Dr Boulain); Service de Réanimation Médicale, Hôpital Henri-Mondor, Assistance Publique, Hôpitaux de Paris, Université Paris XII, Créteil (Dr Fartoukh and Brochard); Service de Réanimation Médicale, Hôpital Lariboisière, Assistance Publique, Hôpitaux de Paris, Université Paris VII, Paris (Dr Baud); Service de Réanimation Médicale, Hôpital Louis Mourier, Assistance Publique, Hôpitaux de Paris, Université Paris VII, Colombes (Dr Boyer), France.
RELATED ARTICLE
The Arc of the Pulmonary Artery Catheter
Robert A. Fowler and Deborah J. Cook
JAMA. 2003;290(20):2732-2734.
EXTRACT
| FULL TEXT
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Mortality Rates for Patients With Acute Lung Injury/ARDS Have Decreased Over Time
Zambon and Vincent
Chest 2008;133:1120-1127.
ABSTRACT
| FULL TEXT
Advances in Critical Care for the Nephrologist: Hemodynamic Monitoring and Volume Management
Davison and Junker
CJASN 2008;3:554-561.
ABSTRACT
| FULL TEXT
Hemodynamic Evaluation and Monitoring in the ICU
Pinsky
Chest 2007;132:2020-2029.
ABSTRACT
| FULL TEXT
The Pulmonary Artery Catheter in Anesthesia Practice in 2007: An Historical Overview With Emphasis on the Past 6 Years
Leibowitz and Oropello
SEMIN CARDIOTHORAC VASC ANESTH 2007;11:162-176.
ABSTRACT
Trends in the Use of the Pulmonary Artery Catheter in the United States, 1993-2004
Wiener and Welch
JAMA 2007;298:423-429.
ABSTRACT
| FULL TEXT
The Pulmonary Artery Catheter, 1967 2007: Rest in Peace?
Rubenfeld et al.
JAMA 2007;298:458-461.
FULL TEXT
Pulmonary artery catheters
Finfer and Delaney
BMJ 2006;333:930-931.
FULL TEXT
Clinical Year in Review III: Critical Care, Mechanical Ventilation, Sleep Medicine, and Lung Cancer
Moss
Proc Am Thorac Soc 2006;3:645-649.
FULL TEXT
Clinical trials of monitoring in anaesthesia, critical care and acute ward care: a review
Young and Griffiths
Br J Anaesth 2006;97:39-45.
ABSTRACT
| FULL TEXT
Pulmonary-Artery versus Central Venous Catheter to Guide Treatment of Acute Lung Injury
The National Heart, Lung, and Blood Institute Acut
NEJM 2006;354:2213-2224.
ABSTRACT
| FULL TEXT
Community-acquired bacterial meningitis.
Abrahamian et al.
NEJM 2006;354:1429-1432.
FULL TEXT
Early and innovative interventions for severe sepsis and septic shock: taking advantage of a window of opportunity
Rivers et al.
CMAJ 2005;173:1054-1065.
ABSTRACT
| FULL TEXT
Impact of the Pulmonary Artery Catheter in Critically Ill Patients: Meta-analysis of Randomized Clinical Trials
Shah et al.
JAMA 2005;294:1664-1670.
ABSTRACT
| FULL TEXT
Use of the Pulmonary Artery Catheter Is Not Associated With Worse Outcome in the ICU
Sakr et al.
Chest 2005;128:2722-2731.
ABSTRACT
| FULL TEXT
Biomarker Responses during and after Treatment with Nesiritide Infusion in Patients with Decompensated Chronic Heart Failure
Miller et al.
Clin. Chem. 2005;51:569-577.
ABSTRACT
| FULL TEXT
The Ethical Conduct of Clinical Research Involving Critically Ill Patients in the United States and Canada: Principles and Recommendations
Am. J. Respir. Crit. Care Med. 2004;170:1375-1384.
FULL TEXT
Medical Devices of the Chest
Hunter et al.
RadioGraphics 2004;24:1725-1746.
ABSTRACT
| FULL TEXT
Additional articles abstracted in ACP Journal Club
Evid. Based Med. 2004;9:99-99.
FULL TEXT
More Negative Data on Early Use of Pulmonary-Artery Catheters
Journal Watch Cardiology 2004;2004:3-3.
FULL TEXT
Pulmonary-Artery Catheters Not Beneficial in Patients with Shock or ARDS
JWatch General 2003;2003:1-1.
FULL TEXT
The Arc of the Pulmonary Artery Catheter
Fowler and Cook
JAMA 2003;290:2732-2734.
FULL TEXT
|
