美国重症监护病房中动脉和中央静脉导管使用的变化。
Variation of arterial and central venous catheter use in United States intensive care units.
机构信息
From the Albert Einstein College of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Medical Center, New York, New York. Current position: Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York (H.B.G.); Section of Critical Care, University of Manitoba, Winnipeg, Manitoba, Canada (A.G.); Cerner Corporation, Vienna, Virginia (A.K.); Interdepartmental Division of Critical Care, University of Toronto, Toronto, Ontario, Canada (D.C.S.); Department of Medicine, University of Toronto School of Medicine, Toronto, Ontario, Canada, and Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (G.R.); and Departments of Anesthesiology and Epidemiology, Columbia University, New York, New York (H.W.).
出版信息
Anesthesiology. 2014 Mar;120(3):650-64. doi: 10.1097/ALN.0000000000000008.
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.
背景
动脉导管（AC）和中心静脉导管（CVC）在重症监护病房（ICU）中很常见。很少有数据描述哪些患者接受这些设备，以及实践中是否存在差异。
方法
作者通过使用项目影响（Project IMPACT）对 2001 年至 2008 年期间入住 ICU 的成年患者进行了一项观察性队列研究，以确定美国 ICU 中 AC 和 CVC 的使用是否一致。作者检查了随时间的趋势以及接受 AC 或 CVC 的可能性更高（机械通气或血管加压药）或更低（预测住院死亡率≤2%）的患者。
结果
我们的队列包括 122 家医院和 168 个 ICU 的 334123 名患者。未调整的 AC 使用率保持不变（2001 年为 36.9%[2001 年] vs. 2008 年为 36.4%[2008 年]；P=0.212），而 CVC 使用增加（从 2001 年的 33.4%增加到 2008 年的 43.8%[2001 年与 2008 年比较，P<0.001]）；从 2004 年（35.2%）到 2008 年（36.4%），调整后的 AC 使用率保持不变（P=0.43 用于趋势）。外科 ICU 最常使用这两种导管（未调整率，AC：56.0%的患者 vs. 22.4%在医疗和 32.6%在联合单位，P<0.001；CVC：46.9% vs. 32.5%和 36.4%，P<0.001）。在接受机械通气的患者中，AC 的使用在 ICU 之间存在很大差异（中位数[四分位距]，49.2%[29.9-72.3%]；调整后的中位数优势比[AMOR]，2.56），使用血管加压药（51.7%[30.8-76.2%]；AMOR，2.64）和预测死亡率为 2%或更低（31.7%[19.5-49.3%]；AMOR，1.94）。CVC 的使用差异较小（机械通气：63.4%[54.9-72.9%]，AMOR，1.69；血管加压药：71.4%（59.5-85.7%），AMOR，1.93；预测死亡率为 2%或更低：18.7%（11.9-27.3%），AMOR，1.90）。
结论
AC 和 CVC 在 ICU 患者中都很常见。AC 的使用比 CVC 更具变异性。
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