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Previous Volume 354:2213-2224 May 25, 2006 Number 21 Next

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ABSTRACT

Background The balance between the benefits and the risks of pulmonary-artery catheters (PACs) has not been established.

Methods We evaluated the relationship of benefits and risks of PACs in 1000 patients with established acute lung injury in a randomized trial comparing hemodynamic management guided by a PAC with hemodynamic management guided by a central venous catheter (CVC) using an explicit management protocol. Mortality during the first 60 days before discharge home was the primary outcome.

Results The groups had similar baseline characteristics. The rates of death during the first 60 days before discharge home were similar in the PAC and CVC groups (27.4 percent and 26.3 percent, respectively; P=0.69; absolute difference, 1.1 percent; 95 percent confidence interval, –4.4 to 6.6 percent), as were the mean (±SE) numbers of both ventilator-free days (13.2±0.5 and 13.5±0.5; P=0.58) and days not spent in the intensive care unit (12.0±0.4 and 12.5±0.5; P=0.40) to day 28. PAC-guided therapy did not improve these measures for patients in shock at the time of enrollment. There were no significant differences between groups in lung or kidney function, rates of hypotension, ventilator settings, or use of dialysis or vasopressors. Approximately 90 percent of protocol instructions were followed in both groups, with a 1 percent rate of crossover from CVC- to PAC-guided therapy. Fluid balance was similar in the two groups, as was the proportion of instructions given for fluid and diuretics. Dobutamine use was uncommon. The PAC group had approximately twice as many catheter-related complications (predominantly arrhythmias).

Conclusions PAC-guided therapy did not improve survival or organ function but was associated with more complications than CVC-guided therapy. These results, when considered with those of previous studies, suggest that the PAC should not be routinely used for the management of acute lung injury. (ClinicalTrials.gov number, NCT00281268 [ClinicalTrials.gov] .)

Source Information

The members of the Writing Committee (Arthur P. Wheeler, M.D., and Gordon R. Bernard, M.D., Vanderbilt University, Nashville; B. Taylor Thompson, M.D., and David Schoenfeld, Ph.D., Massachusetts General Hospital, Boston; Herbert P. Wiedemann, M.D., Cleveland Clinic, Cleveland; Ben deBoisblanc, M.D., Louisiana State University Health Sciences Center, New Orleans; Alfred F. Connors, Jr., M.D., Case Western Reserve University at MetroHealth Medical Center, Cleveland; R. Duncan Hite, M.D., Wake Forest University Health Sciences, Winston-Salem, N.C.; and Andrea L. Harabin, Ph.D., National Institutes of Health, Heart, Lung, and Blood Institute, Bethesda, Md.) assume responsibility for the integrity of the article.

This article was published at www.nejm.org on May 21, 2006.

Address reprint requests to Dr. Wheeler at T-1217 MCN, Vanderbilt Medical Center, Nashville, TN 37232-2650, or at art.wheeler{at}vanderbilt.edu.

Full Text of this Article

Related Letters:

Catheters and the Treatment of Acute Lung Injury
Pastewski A. A., Kupfer Y., Tessler S., Daley M. R., Tornero-Campello G., Wheeler A. P., Wiedemann H. P., Schoenfeld D. A.
Extract | Full Text | PDF  
N Engl J Med 2006; 355:956-958, Aug 31, 2006. Correspondence

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