Division of Critical Care Medicine, Montefiore Medical Center, Bronx, New York.
Department of Anesthesiology, Columbia University, New York, New York3Department of Epidemiology, Columbia University, New York, New York.
JAMA Intern Med. 2014 Nov;174(11):1746-54. doi: 10.1001/jamainternmed.2014.3297.
Arterial catheters are used frequently in intensive care units (ICUs). Clinical effectiveness and adverse events associated with the use of the catheters have not been formally evaluated in clinical studies.
To determine whether an association exists between arterial catheter use and hospital mortality in ICU patients.
DESIGN, SETTING, AND PARTICIPANTS: Propensity-matched cohort analysis of data in the Project IMPACT database, from 2001 to 2008. A total of 139 ICUs in the United States were included. Participants were ICU patients 18 years or older.
Arterial catheter use.
Our main outcome was hospital mortality. We assessed a primary cohort of medical patients requiring mechanical ventilation and 9 secondary cohorts. We used propensity score-matched pairs as the primary analytic strategy. Sensitivity analyses included 4 alternative methods of comparison in the primary cohort: multivariate modeling without propensity adjustment, mixed-effects multivariate logistic regression without propensity adjustment, multivariate modeling with propensity adjustment, and stratification based on propensity quintiles.
Our primary cohort consisted of 60 975 patients; 24 126 of these patients (39.6%) had an arterial catheter in place during their ICU stay, and analyses were based on 13 603 propensity score-matched pairs. We found no association between arterial catheter use and hospital mortality in medical patients requiring mechanical ventilation in the primary analysis (odds ratio [OR], 0.98; 95% CI, 0.93-1.03; P = .40) or the 4 sensitivity analyses (P ≥ .58 for all). In 8 of 9 secondary cohorts we were unable to detect an association between arterial catheter use and hospital mortality. In the cohort of patients receiving vasopressors, arterial catheter use was associated with an increased odds of death (OR, 1.08; 95% CI, 1.02-1.14; P = .008).
In this propensity-matched cohort analysis, arterial catheters were not associated with improvements in hospital mortality in medical ICU patients requiring mechanical ventilation. Given the costs and potential harms associated with invasive catheters, randomized clinical trials are needed to further evaluate the usefulness of these frequently used devices.
动脉导管在重症监护病房（ICU）中经常使用。在临床研究中，尚未对导管使用的临床效果和不良事件进行正式评估。
确定 ICU 患者中动脉导管使用与医院死亡率之间是否存在关联。
设计、环境和参与者：对 2001 年至 2008 年期间项目影响数据库中的数据进行倾向匹配队列分析。美国共有 139 个 ICU 参与研究。参与者为年龄在 18 岁及以上的 ICU 患者。
动脉导管使用。
我们的主要结局是医院死亡率。我们评估了需要机械通气的内科患者的主要队列和 9 个次要队列。我们使用倾向评分匹配对作为主要分析策略。敏感性分析包括主要队列中的 4 种替代比较方法：无倾向调整的多变量建模、无倾向调整的混合效应多变量逻辑回归、倾向调整的多变量建模和基于倾向五分位数的分层。
我们的主要队列包括 60975 例患者；其中 24126 例（39.6%）在 ICU 期间放置了动脉导管，分析基于 13603 对倾向评分匹配对。我们在主要分析中未发现机械通气内科患者使用动脉导管与医院死亡率之间存在关联（比值比[OR]，0.98；95%置信区间[CI]，0.93-1.03；P=0.40）或在 4 项敏感性分析中（所有分析 P≥0.58）均未发现关联。在 9 个次要队列中的 8 个队列中，我们无法检测到动脉导管使用与医院死亡率之间的关联。在接受血管加压素的患者队列中，动脉导管使用与死亡几率增加相关（OR，1.08；95%CI，1.02-1.14；P=0.008）。
在这项倾向评分匹配队列分析中，动脉导管并未改善需要机械通气的内科 ICU 患者的医院死亡率。鉴于侵入性导管相关的成本和潜在危害，需要进行随机临床试验来进一步评估这些常用设备的有用性。
