Pulmonary artery catheters: Evolving rates and reasons for use

Objective: Randomized trials have demonstrated risks and failed to establish a clear benefit for the use of the pulmonary artery catheter. We assessed rates of pulmonary artery catheter use in multiple centers over 5 yrs, variables associated with their use, and how these variables changed over time (2002-2006). Design: A multicenter longitudinal study using the Hamilton Regional Critical Care Database. A two-level multiple logistic regression analysis was used to determine significant variables associated with pulmonary artery catheter use and whether these varied over time. Setting: Academic intensive care units in Hamilton, Canada. Patients: We identified patients from five intensive care units who received a pulmonary artery catheter within the first 2 days of intensive care unit admission. Interventions: Pulmonary artery catheter use over a 5-yr period. Measurements and Main Results: Among 15,006 patients, 1,921 (12.8%) had a pulmonary artery catheter. Adjusted rates of pulmonary artery catheter use decreased from 16.4% to 6.5% over 5 yrs. Determinants of pulmonary artery catheter use included Acute Physiology and Chronic Health Evaluation II score (odds ratio [OR], 1.05; confidence interval [Cl], 1.04 -1.06; p <.0001), elective surgical status (OR, 2.82; Cl, 2.29 -3.48; p <.0001), postabdominal aortic aneurysm repair (OR, 10.91; Cl, 8.24-14.45; p <.0001), cardiogenic shock (OR, 5.31; Cl, 3.35-8.42; p <.0001), sepsis (OR, 2.83; Cl, 1.94-4.13; p <.0001), vasoactive infusion use (OR, 4.04; Cl, 3.47-4.71; p <.0001), and mechanical ventilation (OR, 2.21; Cl, 1.86 -2.63; p <.0001). Physician's base specialty and local intensive care unit were also associated with pulmonary artery catheter use (p <.0001). The determinants of pulmonary artery catheter use did not change over time. Conclusions: We observed a > 50% reduction in the rate of pulmonary artery catheter use over 5 yrs. Patient factors predicting pulmonary artery catheter use were illness severity, specific diagnoses, and the need for advanced life support. Nonpatient factors predicting pulmonary artery catheter use were intensive care unit and the attending physician's base specialty. (Crit Care Med 2011; 39: 1613-1618)