Assessment of the clinical effectiveness of pulmonary artery catheters in management of patients in intensive care (PAC-Man): a randomised controlled trial
Assessment of the clinical effectiveness of pulmonary artery catheters in management of patients in intensive care (PAC-Man): a randomised controlled trial
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DOI：
10.1016/s0140-6736(05)67061-4
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发表时间：
2005-08-06
期刊：
影响因子：
168.9
通讯作者：
Rowan, K
中科院分区：
文献类型：
--
作者：
Harvey, S;Harrison, DA;Rowan, K
在过去的30年里，肺动脉导管（PAC）已成为一种广泛应用于危重患者血流动力学监测的设备，尽管其安全性存在质疑。因此，我们的目的是确定采用paca治疗危重患者是否降低了住院死亡率。方法我们进行了一项随机对照试验，我们从65个英国重症监护病房招募了1041名患者。我们将个体分配到有（n=519）或没有（n=522） PAC的组。插入时间和随后的临床管理由治疗临床医生决定。重症监护病房先验地决定在对照患者中使用另一种心输出量监测装置。1014例患者符合分析条件。我们注意到使用或不使用PAC的患者的住院死亡率没有差异（68% [346 / 506]vs 66% [333 / 507], p=0.39；校正风险比1.09,95% CI 0.94-1.27）。我们注意到486例植入PAC的患者中有46例出现了并发症，没有一例是致命的。我们的研究结果表明，没有明确的证据表明使用PAC管理危重患者是有益还是有害的。如果这些设备不成为多余的技术，需要进行疗效研究，以确定涉及PAC使用的管理方案是否可以改善特定群体的结果。
Background Over the past 30 years the pulmonary artery catheter (PAC) has become a widely used haemodynamic monitoring device in the management of critically ill patients, though doubts exist about its safety. Our aim was, therefore, to ascertain whether hospital mortality is reduced in critically ill patients when they are managed with a PAC.Methods We did a randomised controlled trial to which we enrolled 1041 patients from 65 UK intensive care units. We assigned individuals to management with (n=519) or without (n=522) a PAC. The timing of insertion and subsequent clinical management were at the discretion of the treating clinician. Intensive care units decided a priori to have the option of using an alternative cardiac output-monitoring device in control patients.Findings 1014 patients were eligible for analysis. We noted no difference in hospital mortality between patients managed with or without a PAC (68% [346 of 506] vs 66% [333 of 507], p=0.39; adjusted hazard ratio 1.09, 95% CI 0.94-1.27). We noted complications associated with insertion of a PAC in 46 of 486 individuals in whom the device was placed, none of which was fatal.Interpretation Our findings indicate no clear evidence of benefit or harm by managing critically ill patients with a PAC. Efficacy studies are needed to ascertain whether management protocols involving PAC use can result in improved outcomes in specific groups if these devices are not to become a redundant technology.