Division of Critical Care in the Department of Anesthesia, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA.
J Crit Care. 2011 Apr;26(2):224.e1-8. doi: 10.1016/j.jcrc.2010.07.001. Epub 2010 Sep 1.
This study compared clinical outcomes associated with exposure to pulmonary artery catheters (PACs), central venous catheters (CVCs), arterial pressure waveform analysis for cardiac output (APCO), or no central monitoring (NCM) in patients with shock.
We assessed 6929 consecutive patients from 2003 to 2006 within a surgical intensive care unit of a university hospital, identifying 237 mechanically ventilated patients with shock.
Adjusted for severity of illness, use of APCO monitoring, compared with other options, was associated with reduced intensive care unit mortality (odds ratio [OR], 0.37; 95% confidence interval [CI], 0.18-0.77) and 28-day mortality (OR, 0.43; 95% CI, 0.22-0.85). Other monitors were not associated with changes of 28-day mortality (CVC: OR, 0.63; 95% CI, 0.34-1.17; PAC: OR, 0.78; 95% CI, 0.36-1.69) or were associated with increased risk (NCM: OR, 2.29; 95% CI, 1.14-4.61). There were significant differences in the fluid and vasoactive drug prescriptions among the groups.
This study supports an association between the use of APCO monitoring and reduction in mortality in shock compared with traditional methods of monitoring. Although it is impossible to exclude the role of unrecognized/unrecorded differences among the groups, these findings may result from differences in supportive care, directed by monitor technology.
本研究比较了在休克患者中暴露于肺动脉导管（PAC）、中心静脉导管（CVC）、心输出量动脉压力波形分析（APCO）或无中心监测（NCM）相关的临床结局。
我们评估了 2003 年至 2006 年期间在一家大学医院外科重症监护病房的 6929 名连续患者，确定了 237 名机械通气休克患者。
调整疾病严重程度后，与其他选择相比，使用 APCO 监测与降低重症监护病房死亡率（比值比[OR]，0.37；95%置信区间[CI]，0.18-0.77）和 28 天死亡率（OR，0.43；95%CI，0.22-0.85）相关。其他监测器与 28 天死亡率的变化无关（CVC：OR，0.63；95%CI，0.34-1.17；PAC：OR，0.78；95%CI，0.36-1.69）或与风险增加相关（NCM：OR，2.29；95%CI，1.14-4.61）。
与传统监测方法相比，本研究支持在休克中使用 APCO 监测与降低死亡率之间存在关联。尽管不可能排除各组之间未被识别/未被记录的差异的作用，但这些发现可能是由于监测技术指导的支持性护理的差异所致。
