Kirton Orlando C, Calabrese Rebecca C, Staff Ilene
Department of Surgery, Hartford Hospital, Hartford, CT, USA
Department of Surgery, Hartford Hospital, Hartford, CT, USA.
J Intensive Care Med. 2015 Jan;30(1):30-6. doi: 10.1177/0885066613498055. Epub 2013 Aug 11.
Less-invasive hemodynamic monitoring (eg, esophageal doppler monitoring [EDM] and arterial pressure contour analysis, FloTrac) is increasingly used as an alternative to pulmonary artery catheters (PACs) in critically ill intensive care unit (ICU).
The decrease in use of PACs is not associated with increased mortality.
Five-year retrospective review of 1894 hemodynamically monitored patients admitted to 3 surgical ICUs in a university-affiliate, tertiary care urban hospital. Data included the number of admissions, diagnosis-related group discharge case mix, length of stay, insertion of monitoring devices (PAC, EDM, and FloTrac probes), administered intravenous vasoactive agents (β-predominant agonists--dobutamine, epinephrine, and dopamine; vasopressors--norepinephrine and phenylephrine), and mortality. Data from hospital administrative databases were compiled to create patient characteristic and monitoring variables across a 5-year time period, 2005 to 2009 inclusive. Chi-square for independent proportions, 1-way analysis of variance, and Kruskal-Wallis tests were used; tests for trend were conducted. An α level of .05 was considered significant. Statistical Package for the Social Sciences v14 was used for all statistical testing.
There was a significant change in the type of hemodynamic monitors inserted in 2 of the 3 surgical ICUs (in the general surgery and neurointensive care but not in the cardiac ICU) from PACs to less-invasive devices (FloTrac or EDM) during the 5-year study period (P < .001). There was no change in mortality rate over the time period (P = .492). There was an overall increase in the proportion of monitored patients who received intravenous vasoactive agents (P < .001) with a progressive shift from β-agonists to vasopressors (P < .002). Multivariate analyses indicated that age, case mix, and use of vasoactive agents were all independent predictors of inhospital mortality (P = .001) but that type of monitoring was not (P = .638).
In a 5-year period, the decreased insertions of PACs were replaced by increased utilization of less-invasive hemodynamic monitoring devices. This change in practice did not adversely impact mortality.
在重症监护病房（ICU）中，侵入性较小的血流动力学监测（如食管多普勒监测[EDM]和动脉压轮廓分析、FloTrac）越来越多地被用作肺动脉导管（PAC）的替代方法。
PAC使用的减少与死亡率增加无关。
对一所大学附属医院、三级城市医疗中心的3个外科ICU收治的1894例接受血流动力学监测的患者进行为期5年的回顾性研究。数据包括入院人数、诊断相关分组出院病例组合、住院时间、监测设备（PAC、EDM和FloTrac探头）的置入情况、静脉使用血管活性药物（以β受体激动剂为主——多巴酚丁胺、肾上腺素和多巴胺；血管升压药——去甲肾上腺素和去氧肾上腺素）以及死亡率。收集医院管理数据库中的数据，以建立2005年至2009年这5年期间的患者特征和监测变量。采用独立比例的卡方检验、单因素方差分析和Kruskal-Wallis检验；进行趋势检验。α水平设定为0.05，认为具有统计学意义。所有统计检验均使用社会科学统计软件包v14。
在5年研究期间，3个外科ICU中的2个（普通外科和神经重症监护病房，但心脏ICU未出现此情况）从使用PAC改为使用侵入性较小的设备（FloTrac或EDM）进行血流动力学监测，这种情况有显著变化（P < 0.001）。在此期间死亡率没有变化（P = 0.492）。接受静脉血管活性药物治疗的监测患者比例总体增加（P < 0.001），并且用药逐渐从β受体激动剂转向血管升压药（P < 0.002）。多因素分析表明，年龄、病例组合和血管活性药物的使用均是住院死亡率的独立预测因素（P = 0.001），但监测类型不是（P = 0.638）。
在5年期间，PAC置入减少，取而代之的是侵入性较小的血流动力学监测设备的使用增加。这种实践中的变化并未对死亡率产生不利影响。
