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	Full Text PDF PDA Full Text PowerPoint Slide Set Editorial by Parsons, P. E. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background Some observational studies suggest that the use of pulmonary-artery catheters to guide therapy is associated with increased mortality.

Methods We performed a randomized trial comparing goal-directed therapy guided by a pulmonary-artery catheter with standard care without the use of a pulmonary-artery catheter. The subjects were high-risk patients 60 years of age or older, with American Society of Anesthesiologists (ASA) class III or IV risk, who were scheduled for urgent or elective major surgery, followed by a stay in an intensive care unit. Outcomes were adjudicated by observers who were unaware of the treatment-group assignments. The primary outcome was in-hospital mortality from any cause.

Results Of 3803 eligible patients, 1994 (52.4 percent) underwent randomization. The base-line characteristics of the two treatment groups were similar. A total of 77 of 997 patients who underwent surgery without the use of a pulmonary-artery catheter (7.7 percent) died in the hospital, as compared with 78 of 997 patients in whom a pulmonary-artery catheter was used (7.8 percent) — a difference of 0.1 percentage point (95 percent confidence interval, –2.3 to 2.5). There was a higher rate of pulmonary embolism in the catheter group than in the standard-care group (8 events vs. 0 events, P=0.004). The survival rates at 6 months among patients in the standard-care and catheter groups were 88.1 and 87.4 percent, respectively (difference, –0.7 percentage point [95 percent confidence interval, –3.6 to 2.2]; negative survival differences favor standard care); at 12 months, the rates were 83.9 and 83.0 percent, respectively (difference, –0.9 percentage point [95 percent confidence interval, –4.3 to 2.4]). The median hospital stay was 10 days in each group.

Conclusions We found no benefit to therapy directed by pulmonary-artery catheter over standard care in elderly, high-risk surgical patients requiring intensive care.

Source Information

From the Faculty of Medicine, University of Calgary, Calgary, Alta. (J.D.S., R.D.H., R.F.B., L.K., G.F.P., C.J.D., S.V., A.K.); the Sir Mortimer B. Davis Jewish General Hospital, Montreal (D.P.L.); the Faculty of Medicine, University of Montreal, Montreal (L.P.); the Faculty of Medicine, Dalhousie University, Halifax, N.S. (H.D.); and the University of Alberta, Edmonton (M.J.) — all in Canada.

Address reprint requests to Dr. Sandham at the Department of Critical Care Medicine, EG23 Foothills St. NW, Calgary, AB T2N 2T9, Canada, or at sandham{at}ucalgary.ca.

Full Text of this Article

Related Letters:

Pulmonary-Artery Catheters in High-Risk Surgical Patients
Cholley B. P., Payen D., Karkouti K., Wijeysundera D. N., Beattie S. W., Schwann N. M., Mangano D. T., the Multicenter Study of Perioperative Ischemia Research Group , Sandham J. D., Hull R. D., Brant R. F.
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N Engl J Med 2003; 348:2035-2037, May 15, 2003. Correspondence

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