Variation of arterial and central venous catheter use in United States intensive care units

Hayley B. Gershengorn, Allan Garland, Andrew Kramer, Damon C. Scales, Gordon Rubenfeld, Hannah Wunsch

Research output: Contribution to journalArticle

30 Citations (Scopus)

Abstract

BACKGROUND:: Arterial catheters (ACs) and central venous catheters (CVCs) are common in intensive care units (ICUs). Few data describe which patients receive these devices and whether variability in practice exists. METHODS:: The authors conducted an observational cohort study on adult patients admitted to ICU during 2001-2008 by using Project IMPACT to determine whether AC and CVC use is consistent across U.S. ICUs. The authors examined trends over time and patients more (mechanically ventilated or on vasopressors) or less (predicted risk of hospital mortality ≤2%) likely to receive either catheter. RESULTS:: Our cohort included 334, 123 patients across 122 hospitals and 168 ICUs. Unadjusted AC usage rates remained constant (36.9% [2001] vs. 36.4% [2008]; P = 0.212), whereas CVC use increased (from 33.4% [2001] to 43.8% [2008]; P < 0.001 comparing 2001 and 2008); adjusted AC usage rates were constant from 2004 (35.2%) to 2008 (36.4%; P = 0.43 for trend). Surgical ICUs used both catheters most often (unadjusted rates, ACs: 56.0% of patients vs. 22.4% in medical and 32.6% in combined units, P < 0.001; CVCs: 46.9% vs. 32.5% and 36.4%, P < 0.001). There was a wide variability in AC use across ICUs in patients receiving mechanical ventilation (median [interquartile range], 49.2% [29.9-72.3%]; adjusted median odds ratio [AMOR], 2.56), vasopressors (51.7% [30.8-76.2%]; AMOR, 2.64), and with predicted mortality of 2% or less (31.7% [19.5-49.3%]; AMOR, 1.94). There was less variability in CVC use (mechanical ventilation: 63.4% [54.9-72.9%], AMOR, 1.69; vasopressors: 71.4% (59.5-85.7%), AMOR, 1.93; predicted mortality of 2% or less: 18.7% (11.9-27.3%), AMOR, 1.90). CONCLUSIONS:: Both ACs and CVCs are common in ICU patients. There is more variation in use of ACs than CVCs.

Original languageEnglish (US)
Pages (from-to)650-664
Number of pages15
JournalAnesthesiology
Volume120
Issue number3
DOIs
StatePublished - 2014

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Central Venous Catheters
Intensive Care Units
Catheters
Odds Ratio
Artificial Respiration
Mortality
Critical Care
Hospital Mortality
Observational Studies
Cohort Studies
Equipment and Supplies

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Gershengorn, H. B., Garland, A., Kramer, A., Scales, D. C., Rubenfeld, G., & Wunsch, H. (2014). Variation of arterial and central venous catheter use in United States intensive care units. Anesthesiology, 120(3), 650-664. https://doi.org/10.1097/ALN.0000000000000008

Variation of arterial and central venous catheter use in United States intensive care units. / Gershengorn, Hayley B.; Garland, Allan; Kramer, Andrew; Scales, Damon C.; Rubenfeld, Gordon; Wunsch, Hannah.

In: Anesthesiology, Vol. 120, No. 3, 2014, p. 650-664.

Research output: Contribution to journalArticle

Gershengorn, HB, Garland, A, Kramer, A, Scales, DC, Rubenfeld, G & Wunsch, H 2014, 'Variation of arterial and central venous catheter use in United States intensive care units', Anesthesiology, vol. 120, no. 3, pp. 650-664. https://doi.org/10.1097/ALN.0000000000000008
Gershengorn, Hayley B. ; Garland, Allan ; Kramer, Andrew ; Scales, Damon C. ; Rubenfeld, Gordon ; Wunsch, Hannah. / Variation of arterial and central venous catheter use in United States intensive care units. In: Anesthesiology. 2014 ; Vol. 120, No. 3. pp. 650-664.
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abstract = "BACKGROUND:: Arterial catheters (ACs) and central venous catheters (CVCs) are common in intensive care units (ICUs). Few data describe which patients receive these devices and whether variability in practice exists. METHODS:: The authors conducted an observational cohort study on adult patients admitted to ICU during 2001-2008 by using Project IMPACT to determine whether AC and CVC use is consistent across U.S. ICUs. The authors examined trends over time and patients more (mechanically ventilated or on vasopressors) or less (predicted risk of hospital mortality ≤2{\%}) likely to receive either catheter. RESULTS:: Our cohort included 334, 123 patients across 122 hospitals and 168 ICUs. Unadjusted AC usage rates remained constant (36.9{\%} [2001] vs. 36.4{\%} [2008]; P = 0.212), whereas CVC use increased (from 33.4{\%} [2001] to 43.8{\%} [2008]; P < 0.001 comparing 2001 and 2008); adjusted AC usage rates were constant from 2004 (35.2{\%}) to 2008 (36.4{\%}; P = 0.43 for trend). Surgical ICUs used both catheters most often (unadjusted rates, ACs: 56.0{\%} of patients vs. 22.4{\%} in medical and 32.6{\%} in combined units, P < 0.001; CVCs: 46.9{\%} vs. 32.5{\%} and 36.4{\%}, P < 0.001). There was a wide variability in AC use across ICUs in patients receiving mechanical ventilation (median [interquartile range], 49.2{\%} [29.9-72.3{\%}]; adjusted median odds ratio [AMOR], 2.56), vasopressors (51.7{\%} [30.8-76.2{\%}]; AMOR, 2.64), and with predicted mortality of 2{\%} or less (31.7{\%} [19.5-49.3{\%}]; AMOR, 1.94). There was less variability in CVC use (mechanical ventilation: 63.4{\%} [54.9-72.9{\%}], AMOR, 1.69; vasopressors: 71.4{\%} (59.5-85.7{\%}), AMOR, 1.93; predicted mortality of 2{\%} or less: 18.7{\%} (11.9-27.3{\%}), AMOR, 1.90). CONCLUSIONS:: Both ACs and CVCs are common in ICU patients. There is more variation in use of ACs than CVCs.",
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T1 - Variation of arterial and central venous catheter use in United States intensive care units

AU - Gershengorn, Hayley B.

AU - Garland, Allan

AU - Kramer, Andrew

AU - Scales, Damon C.

AU - Rubenfeld, Gordon

AU - Wunsch, Hannah

PY - 2014

Y1 - 2014

N2 - BACKGROUND:: Arterial catheters (ACs) and central venous catheters (CVCs) are common in intensive care units (ICUs). Few data describe which patients receive these devices and whether variability in practice exists. METHODS:: The authors conducted an observational cohort study on adult patients admitted to ICU during 2001-2008 by using Project IMPACT to determine whether AC and CVC use is consistent across U.S. ICUs. The authors examined trends over time and patients more (mechanically ventilated or on vasopressors) or less (predicted risk of hospital mortality ≤2%) likely to receive either catheter. RESULTS:: Our cohort included 334, 123 patients across 122 hospitals and 168 ICUs. Unadjusted AC usage rates remained constant (36.9% [2001] vs. 36.4% [2008]; P = 0.212), whereas CVC use increased (from 33.4% [2001] to 43.8% [2008]; P < 0.001 comparing 2001 and 2008); adjusted AC usage rates were constant from 2004 (35.2%) to 2008 (36.4%; P = 0.43 for trend). Surgical ICUs used both catheters most often (unadjusted rates, ACs: 56.0% of patients vs. 22.4% in medical and 32.6% in combined units, P < 0.001; CVCs: 46.9% vs. 32.5% and 36.4%, P < 0.001). There was a wide variability in AC use across ICUs in patients receiving mechanical ventilation (median [interquartile range], 49.2% [29.9-72.3%]; adjusted median odds ratio [AMOR], 2.56), vasopressors (51.7% [30.8-76.2%]; AMOR, 2.64), and with predicted mortality of 2% or less (31.7% [19.5-49.3%]; AMOR, 1.94). There was less variability in CVC use (mechanical ventilation: 63.4% [54.9-72.9%], AMOR, 1.69; vasopressors: 71.4% (59.5-85.7%), AMOR, 1.93; predicted mortality of 2% or less: 18.7% (11.9-27.3%), AMOR, 1.90). CONCLUSIONS:: Both ACs and CVCs are common in ICU patients. There is more variation in use of ACs than CVCs.

AB - BACKGROUND:: Arterial catheters (ACs) and central venous catheters (CVCs) are common in intensive care units (ICUs). Few data describe which patients receive these devices and whether variability in practice exists. METHODS:: The authors conducted an observational cohort study on adult patients admitted to ICU during 2001-2008 by using Project IMPACT to determine whether AC and CVC use is consistent across U.S. ICUs. The authors examined trends over time and patients more (mechanically ventilated or on vasopressors) or less (predicted risk of hospital mortality ≤2%) likely to receive either catheter. RESULTS:: Our cohort included 334, 123 patients across 122 hospitals and 168 ICUs. Unadjusted AC usage rates remained constant (36.9% [2001] vs. 36.4% [2008]; P = 0.212), whereas CVC use increased (from 33.4% [2001] to 43.8% [2008]; P < 0.001 comparing 2001 and 2008); adjusted AC usage rates were constant from 2004 (35.2%) to 2008 (36.4%; P = 0.43 for trend). Surgical ICUs used both catheters most often (unadjusted rates, ACs: 56.0% of patients vs. 22.4% in medical and 32.6% in combined units, P < 0.001; CVCs: 46.9% vs. 32.5% and 36.4%, P < 0.001). There was a wide variability in AC use across ICUs in patients receiving mechanical ventilation (median [interquartile range], 49.2% [29.9-72.3%]; adjusted median odds ratio [AMOR], 2.56), vasopressors (51.7% [30.8-76.2%]; AMOR, 2.64), and with predicted mortality of 2% or less (31.7% [19.5-49.3%]; AMOR, 1.94). There was less variability in CVC use (mechanical ventilation: 63.4% [54.9-72.9%], AMOR, 1.69; vasopressors: 71.4% (59.5-85.7%), AMOR, 1.93; predicted mortality of 2% or less: 18.7% (11.9-27.3%), AMOR, 1.90). CONCLUSIONS:: Both ACs and CVCs are common in ICU patients. There is more variation in use of ACs than CVCs.

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