Association between arterial catheter use and hospital mortality in intensive care units

Hayley B. Gershengorn, Hannah Wunsch, Damon C. Scales, Ryan Zarychanski, Gordon Rubenfeld, Allan Garland

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

IMPORTANCE: Arterial catheters are used frequently in intensive care units (ICUs). Clinical effectiveness and adverse events associated with the use of the catheters have not been formally evaluated in clinical studies. OBJECTIVE: To determine whether an association exists between arterial catheter use and hospital mortality in ICU patients. DESIGN, SETTING, AND PARTICIPANTS: Propensity-matched cohort analysis of data in the Project IMPACT database, from 2001 to 2008. A total of 139 ICUs in the United States were included. Participants were ICU patients 18 years or older. EXPOSURE: Arterial catheter use. MAIN OUTCOMES AND MEASURES: Our main outcome was hospital mortality. We assessed a primary cohort of medical patients requiring mechanical ventilation and 9 secondary cohorts. We used propensity score-matched pairs as the primary analytic strategy. Sensitivity analyses included 4 alternative methods of comparison in the primary cohort: multivariate modeling without propensity adjustment, mixed-effects multivariate logistic regression without propensity adjustment, multivariate modeling with propensity adjustment, and stratification based on propensity quintiles. RESULTS: Our primary cohort consisted of 60 975 patients; 24 126 of these patients (39.6%) had an arterial catheter in place during their ICU stay, and analyses were based on 13 603 propensity score-matched pairs. We found no association between arterial catheter use and hospital mortality in medical patients requiring mechanical ventilation in the primary analysis (odds ratio [OR], 0.98; 95% CI, 0.93-1.03; P = .40) or the 4 sensitivity analyses (P ≥ .58 for all). In 8 of 9 secondary cohorts we were unable to detect an association between arterial catheter use and hospital mortality. In the cohort of patients receiving vasopressors, arterial catheter use was associated with an increased odds of death (OR, 1.08; 95%CI, 1.02-1.14; P = .008). CONCLUSIONS AND RELEVANCE: In this propensity-matched cohort analysis, arterial catheters were not associated with improvements in hospital mortality in medical ICU patients requiring mechanical ventilation. Given the costs and potential harms associated with invasive catheters, randomized clinical trials are needed to further evaluate the usefulness of these frequently used devices.

Original languageEnglish (US)
Pages (from-to)1746-1754
Number of pages9
JournalJAMA Internal Medicine
Volume174
Issue number11
DOIs
StatePublished - Nov 1 2014

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Hospital Mortality
Intensive Care Units
Catheters
Artificial Respiration
Propensity Score
Cohort Studies
Odds Ratio
Randomized Controlled Trials
Logistic Models
Databases
Costs and Cost Analysis
Equipment and Supplies

ASJC Scopus subject areas

  • Internal Medicine
  • Medicine(all)

Cite this

Gershengorn, H. B., Wunsch, H., Scales, D. C., Zarychanski, R., Rubenfeld, G., & Garland, A. (2014). Association between arterial catheter use and hospital mortality in intensive care units. JAMA Internal Medicine, 174(11), 1746-1754. https://doi.org/10.1001/jamainternmed.2014.3297

Association between arterial catheter use and hospital mortality in intensive care units. / Gershengorn, Hayley B.; Wunsch, Hannah; Scales, Damon C.; Zarychanski, Ryan; Rubenfeld, Gordon; Garland, Allan.

In: JAMA Internal Medicine, Vol. 174, No. 11, 01.11.2014, p. 1746-1754.

Research output: Contribution to journalArticle

Gershengorn, HB, Wunsch, H, Scales, DC, Zarychanski, R, Rubenfeld, G & Garland, A 2014, 'Association between arterial catheter use and hospital mortality in intensive care units', JAMA Internal Medicine, vol. 174, no. 11, pp. 1746-1754. https://doi.org/10.1001/jamainternmed.2014.3297
Gershengorn HB, Wunsch H, Scales DC, Zarychanski R, Rubenfeld G, Garland A. Association between arterial catheter use and hospital mortality in intensive care units. JAMA Internal Medicine. 2014 Nov 1;174(11):1746-1754. https://doi.org/10.1001/jamainternmed.2014.3297
Gershengorn, Hayley B. ; Wunsch, Hannah ; Scales, Damon C. ; Zarychanski, Ryan ; Rubenfeld, Gordon ; Garland, Allan. / Association between arterial catheter use and hospital mortality in intensive care units. In: JAMA Internal Medicine. 2014 ; Vol. 174, No. 11. pp. 1746-1754.
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abstract = "IMPORTANCE: Arterial catheters are used frequently in intensive care units (ICUs). Clinical effectiveness and adverse events associated with the use of the catheters have not been formally evaluated in clinical studies. OBJECTIVE: To determine whether an association exists between arterial catheter use and hospital mortality in ICU patients. DESIGN, SETTING, AND PARTICIPANTS: Propensity-matched cohort analysis of data in the Project IMPACT database, from 2001 to 2008. A total of 139 ICUs in the United States were included. Participants were ICU patients 18 years or older. EXPOSURE: Arterial catheter use. MAIN OUTCOMES AND MEASURES: Our main outcome was hospital mortality. We assessed a primary cohort of medical patients requiring mechanical ventilation and 9 secondary cohorts. We used propensity score-matched pairs as the primary analytic strategy. Sensitivity analyses included 4 alternative methods of comparison in the primary cohort: multivariate modeling without propensity adjustment, mixed-effects multivariate logistic regression without propensity adjustment, multivariate modeling with propensity adjustment, and stratification based on propensity quintiles. RESULTS: Our primary cohort consisted of 60 975 patients; 24 126 of these patients (39.6{\%}) had an arterial catheter in place during their ICU stay, and analyses were based on 13 603 propensity score-matched pairs. We found no association between arterial catheter use and hospital mortality in medical patients requiring mechanical ventilation in the primary analysis (odds ratio [OR], 0.98; 95{\%} CI, 0.93-1.03; P = .40) or the 4 sensitivity analyses (P ≥ .58 for all). In 8 of 9 secondary cohorts we were unable to detect an association between arterial catheter use and hospital mortality. In the cohort of patients receiving vasopressors, arterial catheter use was associated with an increased odds of death (OR, 1.08; 95{\%}CI, 1.02-1.14; P = .008). CONCLUSIONS AND RELEVANCE: In this propensity-matched cohort analysis, arterial catheters were not associated with improvements in hospital mortality in medical ICU patients requiring mechanical ventilation. Given the costs and potential harms associated with invasive catheters, randomized clinical trials are needed to further evaluate the usefulness of these frequently used devices.",
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