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Original Research: Critical Care |

The Association Between Indwelling Arterial Catheters and Mortality in Hemodynamically Stable Patients With Respiratory FailureArterial Catheter Use in Respiratory Failure: A Propensity Score Analysis

Douglas J. Hsu, MD; Mengling Feng, PhD; Rishi Kothari, MD; Hufeng Zhou, PhD; Kenneth P. Chen, MD; Leo A. Celi, MD, MPH
Author and Funding Information

From the Department of Medicine (Drs Hsu, Chen, and Celi), Beth Israel Deaconess Medical Center, Boston, MA; the Laboratory of Computational Physiology (Drs Feng and Celi), Massachusetts Institute of Technology, Cambridge, MA; Institute for Infocomm Research (Dr Feng), Singapore; the Department of Anesthesia (Dr Kothari), Mount Sinai Hospital, New York, NY; the Department of Medicine (Dr Zhou), Brigham and Women’s Hospital, Boston, MA; and the Department of Microbiology and Immunobiology (Dr Zhou), Harvard University, Cambridge, MA.

CORRESPONDENCE TO: Douglas J. Hsu, MD, Department of Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Ave, KSB-23, Boston, MA 02215; e-mail: dhsu@bidmc.harvard.edu


Drs Hsu and Feng contributed equally to this work.

FUNDING/SUPPORT: This study was supported by the National Institute of Biomedical Imaging and Bioengineering [Grant R01 EB001659]. Dr Feng is supported by an A*STAR Graduate Scholarship.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2015;148(6):1470-1476. doi:10.1378/chest.15-0516
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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.

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