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Clinical Investigations in Critical Care |

Use of the Pulmonary Artery Catheter Is Not Associated With Worse Outcome in the ICU*

Yasser Sakr, MB BCh, MSc; Jean-Louis Vincent, MD, PhD, FCCP; Konrad Reinhart, MD, PhD; Didier Payen, MD; Christian J. Wiedermann, MD; Durk F. Zandstra, MD; Charles L. Sprung, MD; on behalf of the Sepsis Occurrence in Acutely Ill Patients Investigators
Author and Funding Information

Affiliations: *From the Department of Intensive Care (Drs. Sakr and Vincent), Erasme Hospital, Free University of Brussels, Belgium; Department of Anesthesiology and Intensive Care (Dr. Reinhart), Friedrich-Schiller-University Jena, Germany; Department of Anesthesiology and Intensive Care (Dr. Payen), Centre Hospitalier Universitaire Lariboisiere, Paris, France; Department of Internal Medicine (Dr. Wiedermann), University of Innsbruck, Innsbruck, Austria; Department of Intensive Care (Dr. Zandstra), Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands; and Department of Anesthesiology and Critical Care Medicine (Dr. Sprung), Hadassah Hebrew University Medical Center, Jerusalem, Israel.,  A list of the SOAP Investigators is given in the Appendix.

Correspondence to: Jean-Louis Vincent, MD, PhD, FCCP, Department of Intensive Care, Erasme University Hospital, Route de Lennik 808, B-1070 Brussels, Belgium; e-mail: jlvincen@ulb.ac.be



Chest. 2005;128(4):2722-2731. doi:10.1378/chest.128.4.2722
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Study objectives: In critically ill patients, the impact of pulmonary artery catheter (PAC) use on outcome is debatable. We investigated the epidemiology of PAC use in European ICUs and its relation to outcome.

Design: International cohort, observational study

Setting: One hundred ninety-eight European ICUs participating in the Sepsis Occurrence in Acutely Ill Patients Study.

Patients: All 3,147 adult patients admitted to one of the participating ICUs between May 1, 2002, and May 15, 2002.

Interventions: None.

Measurements and results: Patients were classified according to whether or not they had a PAC at any time during their ICU stay, and were followed up until death, hospital discharge, or for 60 days. Propensity score case matching was performed, and matched pairs were examined for baseline characteristics and outcome. Of 3,147 patients, 481 patients (15.3%) had a PAC. Patients with a PAC were older, had a higher incidence of heart failure, a lower incidence of cancer, and were more commonly surgical admissions. Fluid balance was comparable between the two groups. ICU and hospital mortality rates were higher in patients with a PAC (28.1% vs 16.8% and 32.5% vs 22.5%, respectively; p < 0.001). However, PAC use was not an independent risk factor for 60-day mortality in multivariate analysis, and in 453 propensity-matched pairs ICU and hospital mortality rates were comparable between groups (26.7% vs 26.3% and 31.4% vs 32.8%, p = not significant). Survival to 60 days was similar between the two matched groups (log rank = 0.02; p = 0.894).

Conclusions: This observational study suggests that PAC use is not associated with increased mortality in this heterogeneous population.

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