A randomised, controlled trial of the pulmonary artery catheter in critically ill patients
A randomised, controlled trial of the pulmonary artery catheter in critically ill patients
复制标题
DOI：
10.1007/s00134-002-1206-9
复制
发表时间：
2002-03-01
影响因子：
38.9
通讯作者：
Bennett, ED
中科院分区：
文献类型：
--
作者：
Rhodes, A;Cusack, RJ;Bennett, ED
目的：比较使用肺动脉导管（PAC）与未使用PAC治疗的危重患者的生存率和临床结局。设计：1997年10月至1999年2月的前瞻性、随机、对照临床试验。设置：成人重症监护病房在一家大型教学医院。患者：201例重症患者随机分配至PAC组（n=95）或对照组（n=106）。对照组中有1例患者退出研究，PAC组中有5例患者未接受PAC。所有参与者都可以接受随访。干预措施：参与者被分配到使用PAC（PAC组）或不使用PAC（对照组）进行管理。主要结局指标：在意向治疗的基础上，对成功接受PAC的受试者的28天生存期、重症监护和住院时间以及器官功能障碍进行了比较，并对成功接受PAC的受试者进行了亚组比较。结果如下：PAC组[46/95（47.9%）]和对照组[50/106（47.6）]之间的死亡率无显著差异（差异的95%置信区间为-13至14%，p>0.99）。根据PAC信息进行管理决策的参与者的死亡率为41/91（45%，95%置信区间-11至16%，p=0.77）。PAC组在最初24小时内的液体量明显更多（4953（3140，7000）vs 4292（2535，6049）零），肾衰竭的发生率增加（随机化后第3天35 vs 20%的患者），
Objective: To compare the survival and clinical outcomes of critically ill patients treated with the use of a pulmonary artery catheter (PAC) to those treated without the use of a PAC. Design: Prospective, randomised, controlled, clinical trial from October 1997 to February 1999. Setting: Adult intensive care unit at a large teaching hospital. Patients: Two hundred one critically ill patients were randomised either to a PAC group (n=95) or the control group (n=106). One patient in the control group was withdrawn from the study and five patients in the PAC group did not receive a PAC. All participants were available for follow-up. Interventions: Participants were assigned to be managed either with the use of a PAC (PAC a group) or without the use of a PAC (control group). Main outcome measures: Survival to 28 days, intensive care and hospital length of stay and organ dysfunction were compared on an intention-to-treat basis and also on a subgroup basis for those participants who Successfully received a PAC. Results: There was no significant difference in mortality between the PAC group [46/95 (47.9%)] and the control group [50/106 (47.6)] (95% confidence intervals for the difference -13 to 14%, p>0.99). The mortality for participants who had management decisions based on information derived from a PAC was 41/91 (45%, 95% confidence intervals -11 to 16%, p=0.77). The PAC group had significantly more fluids in the first 24 h (4953 (3140, 7000) versus 4292 (2535, 6049) nil) and an increased incidence of renal failure (35 versus 20% of patients at day 3 post randomisation p