Understanding changes in established practice

Pulmonary artery catheter use in critically iii patients

Hayley B. Gershengorn, Hannah Wunsch

Research output: Contribution to journalArticle

29 Citations (Scopus)

Abstract

OBJECTIVE:: Multiple studies suggest that routine use of pulmonary artery catheters is not beneficial in critically ill patients. Little is known about the patterns of "uptake" of practice change that involves removal of a device previously considered standard of care, rather than adoption of a new technique or technology. Our objective was to assess recent pulmonary artery catheter use across ICUs and identify factors associated with high use. DESIGN:: Cohort study. SETTING:: U.S. ICUs in Project IMPACT. PATIENTS:: Adult ICU admissions from 2001 to 2008. INTERVENTIONS:: None. MEASUREMENTS AND MAIN RESULTS:: Trends in pulmonary artery catheter use from 2001 to 2008 were assessed. For 2006-2008, we compared pulmonary artery catheter use across ICUs. We assessed characteristics of ICUs and hospitals in the top quartile for in-ICU pulmonary artery catheter placement (vs the bottom quartile) using chi-square and t tests and factors associated with in-ICU pulmonary artery catheter insertion using multilevel mixed effects logistic regression. Total pulmonary artery catheter use decreased from 10.8% of patients (2001-2003) to 6.2% (2006-2008; p < 0.001); insertion of pulmonary artery catheters in ICU decreased from 4.2% to 2.2% (p < 0.001). In 2006-2008, ICUs in the top quartile for in-ICU pulmonary artery catheter insertion (3.4-25.0% of patients) were more often surgical (54.2% vs 21.7% in the lowest quartile, p = 0.070), teaching hospitals (54.2% vs 4.3%, p = 0.001), and had surgeon leadership (40.9% vs 13.0%, p = 0.067). After multivariable regression, surgical patients (p < 0.001) and all patients in surgical ICUs (p = 0.057) were more likely to have pulmonary artery catheters placed in ICU. CONCLUSIONS:: Use of pulmonary artery catheters in ICU patients has declined but with significant variation across units. Removal of this technology has occurred most in nonsurgical ICUs and patients.

Original languageEnglish (US)
Pages (from-to)2667-2676
Number of pages10
JournalCritical Care Medicine
Volume41
Issue number12
DOIs
StatePublished - Dec 2013

Fingerprint

Pulmonary Artery
Catheters
Device Removal
Technology
Chi-Square Distribution
Standard of Care
Critical Illness
Teaching Hospitals
Cohort Studies
Logistic Models

Keywords

  • Catheterization
  • Endovascular procedures
  • Epidemiology
  • Evidence-based medicine
  • Intensive care
  • Swan-Ganz
  • Utilization

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Understanding changes in established practice : Pulmonary artery catheter use in critically iii patients. / Gershengorn, Hayley B.; Wunsch, Hannah.

In: Critical Care Medicine, Vol. 41, No. 12, 12.2013, p. 2667-2676.

Research output: Contribution to journalArticle

Gershengorn, Hayley B. ; Wunsch, Hannah. / Understanding changes in established practice : Pulmonary artery catheter use in critically iii patients. In: Critical Care Medicine. 2013 ; Vol. 41, No. 12. pp. 2667-2676.
@article{3a777876a1dc4666875e1b8d1c639875,
title = "Understanding changes in established practice: Pulmonary artery catheter use in critically iii patients",
abstract = "OBJECTIVE:: Multiple studies suggest that routine use of pulmonary artery catheters is not beneficial in critically ill patients. Little is known about the patterns of {"}uptake{"} of practice change that involves removal of a device previously considered standard of care, rather than adoption of a new technique or technology. Our objective was to assess recent pulmonary artery catheter use across ICUs and identify factors associated with high use. DESIGN:: Cohort study. SETTING:: U.S. ICUs in Project IMPACT. PATIENTS:: Adult ICU admissions from 2001 to 2008. INTERVENTIONS:: None. MEASUREMENTS AND MAIN RESULTS:: Trends in pulmonary artery catheter use from 2001 to 2008 were assessed. For 2006-2008, we compared pulmonary artery catheter use across ICUs. We assessed characteristics of ICUs and hospitals in the top quartile for in-ICU pulmonary artery catheter placement (vs the bottom quartile) using chi-square and t tests and factors associated with in-ICU pulmonary artery catheter insertion using multilevel mixed effects logistic regression. Total pulmonary artery catheter use decreased from 10.8{\%} of patients (2001-2003) to 6.2{\%} (2006-2008; p < 0.001); insertion of pulmonary artery catheters in ICU decreased from 4.2{\%} to 2.2{\%} (p < 0.001). In 2006-2008, ICUs in the top quartile for in-ICU pulmonary artery catheter insertion (3.4-25.0{\%} of patients) were more often surgical (54.2{\%} vs 21.7{\%} in the lowest quartile, p = 0.070), teaching hospitals (54.2{\%} vs 4.3{\%}, p = 0.001), and had surgeon leadership (40.9{\%} vs 13.0{\%}, p = 0.067). After multivariable regression, surgical patients (p < 0.001) and all patients in surgical ICUs (p = 0.057) were more likely to have pulmonary artery catheters placed in ICU. CONCLUSIONS:: Use of pulmonary artery catheters in ICU patients has declined but with significant variation across units. Removal of this technology has occurred most in nonsurgical ICUs and patients.",
keywords = "Catheterization, Endovascular procedures, Epidemiology, Evidence-based medicine, Intensive care, Swan-Ganz, Utilization",
author = "Gershengorn, {Hayley B.} and Hannah Wunsch",
year = "2013",
month = "12",
doi = "10.1097/CCM.0b013e318298a41e",
language = "English (US)",
volume = "41",
pages = "2667--2676",
journal = "Critical Care Medicine",
issn = "0090-3493",
publisher = "Lippincott Williams and Wilkins",
number = "12",

}

TY - JOUR

T1 - Understanding changes in established practice

T2 - Pulmonary artery catheter use in critically iii patients

AU - Gershengorn, Hayley B.

AU - Wunsch, Hannah

PY - 2013/12

Y1 - 2013/12

N2 - OBJECTIVE:: Multiple studies suggest that routine use of pulmonary artery catheters is not beneficial in critically ill patients. Little is known about the patterns of "uptake" of practice change that involves removal of a device previously considered standard of care, rather than adoption of a new technique or technology. Our objective was to assess recent pulmonary artery catheter use across ICUs and identify factors associated with high use. DESIGN:: Cohort study. SETTING:: U.S. ICUs in Project IMPACT. PATIENTS:: Adult ICU admissions from 2001 to 2008. INTERVENTIONS:: None. MEASUREMENTS AND MAIN RESULTS:: Trends in pulmonary artery catheter use from 2001 to 2008 were assessed. For 2006-2008, we compared pulmonary artery catheter use across ICUs. We assessed characteristics of ICUs and hospitals in the top quartile for in-ICU pulmonary artery catheter placement (vs the bottom quartile) using chi-square and t tests and factors associated with in-ICU pulmonary artery catheter insertion using multilevel mixed effects logistic regression. Total pulmonary artery catheter use decreased from 10.8% of patients (2001-2003) to 6.2% (2006-2008; p < 0.001); insertion of pulmonary artery catheters in ICU decreased from 4.2% to 2.2% (p < 0.001). In 2006-2008, ICUs in the top quartile for in-ICU pulmonary artery catheter insertion (3.4-25.0% of patients) were more often surgical (54.2% vs 21.7% in the lowest quartile, p = 0.070), teaching hospitals (54.2% vs 4.3%, p = 0.001), and had surgeon leadership (40.9% vs 13.0%, p = 0.067). After multivariable regression, surgical patients (p < 0.001) and all patients in surgical ICUs (p = 0.057) were more likely to have pulmonary artery catheters placed in ICU. CONCLUSIONS:: Use of pulmonary artery catheters in ICU patients has declined but with significant variation across units. Removal of this technology has occurred most in nonsurgical ICUs and patients.

AB - OBJECTIVE:: Multiple studies suggest that routine use of pulmonary artery catheters is not beneficial in critically ill patients. Little is known about the patterns of "uptake" of practice change that involves removal of a device previously considered standard of care, rather than adoption of a new technique or technology. Our objective was to assess recent pulmonary artery catheter use across ICUs and identify factors associated with high use. DESIGN:: Cohort study. SETTING:: U.S. ICUs in Project IMPACT. PATIENTS:: Adult ICU admissions from 2001 to 2008. INTERVENTIONS:: None. MEASUREMENTS AND MAIN RESULTS:: Trends in pulmonary artery catheter use from 2001 to 2008 were assessed. For 2006-2008, we compared pulmonary artery catheter use across ICUs. We assessed characteristics of ICUs and hospitals in the top quartile for in-ICU pulmonary artery catheter placement (vs the bottom quartile) using chi-square and t tests and factors associated with in-ICU pulmonary artery catheter insertion using multilevel mixed effects logistic regression. Total pulmonary artery catheter use decreased from 10.8% of patients (2001-2003) to 6.2% (2006-2008; p < 0.001); insertion of pulmonary artery catheters in ICU decreased from 4.2% to 2.2% (p < 0.001). In 2006-2008, ICUs in the top quartile for in-ICU pulmonary artery catheter insertion (3.4-25.0% of patients) were more often surgical (54.2% vs 21.7% in the lowest quartile, p = 0.070), teaching hospitals (54.2% vs 4.3%, p = 0.001), and had surgeon leadership (40.9% vs 13.0%, p = 0.067). After multivariable regression, surgical patients (p < 0.001) and all patients in surgical ICUs (p = 0.057) were more likely to have pulmonary artery catheters placed in ICU. CONCLUSIONS:: Use of pulmonary artery catheters in ICU patients has declined but with significant variation across units. Removal of this technology has occurred most in nonsurgical ICUs and patients.

KW - Catheterization

KW - Endovascular procedures

KW - Epidemiology

KW - Evidence-based medicine

KW - Intensive care

KW - Swan-Ganz

KW - Utilization

UR - http://www.scopus.com/inward/record.url?scp=84889259573&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84889259573&partnerID=8YFLogxK

U2 - 10.1097/CCM.0b013e318298a41e

DO - 10.1097/CCM.0b013e318298a41e

M3 - Article

VL - 41

SP - 2667

EP - 2676

JO - Critical Care Medicine

JF - Critical Care Medicine

SN - 0090-3493

IS - 12

ER -