Key result
Pulmonary artery catheterization in severe sepsis had no significant impact on mortality (OR 0.83; 95% CI 0.38-1.83; p=0.646) but was associated with significantly longer ICU stays and higher charges.
Why the study?
Does pulmonary artery catheterization improve survival or affect resource expenditures in patients with severe sepsis?
Cohort (n=132)
No
Does pulmonary artery catheterization improve survival or affect resource expenditures in patients with severe sepsis?
In patients with severe sepsis, pulmonary artery catheterization does not improve mortality but is associated with significantly increased length of stay and hospital charges.
Answers are grounded in this paper and cite their sources.
PAC should not yet alter sepsis management; hypothesis-generating for RCTs on hemodynamic monitoring.
Purpose: An economic evaluation of the treatment of severe sepsis, utilizing pulmonary artery catheterization. Subjects and methods: Retrospective cohort analysis conducted in a multidisciplinary tertiary care, intensive care unit directed by full-time intensivists. One hundred and thirty two patients with severe sepsis receiving care in the intensive care unit (ICU) were evaluated for survival, ICU and hospital length of stay, and resource expenditures associated with pulmonary artery catheterization. Results: Pulmonary artery catheters (PAC) were inserted in approximately two-thirds (85 of 132, 64.4%) of patients. No differences in severity adjusted comparisons of mortality based on PAC use were observed: OR=0.83 for PAC use: 95% CI (0.38,1.83), p=0.646. Patients with pulmonary artery catheters had a significantly longer ICU length of stay (11.9 vs. 5.1 days, p=0.002) and greater charges ($23,646 vs. $5709, p<0.001) than patients without PAC. Hospital length of stay (33.9 vs. 17.8 days, p<0.001) and charges ($42,541 vs. $16,537, p=0.001) were also greater for catheterized patients. Conclusion: Adjusting for severity of illness, the use of pulmonary artery catheters had no impact on mortality of patients with severe sepsis in an intensivist managed ICU. Length of stay and charges were significantly greater for those patients managed with pulmonary artery catheters. A randomized controlled trial of pulmonary artery catheterization for severe sepsis patients should include a detailed economic analysis.
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McGee et al. (2000) conducted a cohort in Severe sepsis (n=132). Pulmonary artery catheterization vs. No pulmonary artery catheterization was evaluated on Mortality (OR 0.83, 95% CI 0.38-1.83, p=0.646). Pulmonary artery catheterization in severe sepsis had no significant impact on mortality (OR 0.83; 95% CI 0.38-1.83; p=0.646) but was associated with significantly longer ICU stays and higher charges.
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