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. 2015 Dec;148(6):1470-1476.
doi: 10.1378/chest.15-0516.

The Association Between Indwelling Arterial Catheters and Mortality in Hemodynamically Stable Patients With Respiratory Failure: A Propensity Score Analysis

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Free PMC article

The Association Between Indwelling Arterial Catheters and Mortality in Hemodynamically Stable Patients With Respiratory Failure: A Propensity Score Analysis

Douglas J Hsu et al. Chest. .
Free PMC article

Abstract

Background: Indwelling arterial catheters (IACs) are used extensively in the ICU for hemodynamic monitoring and for blood gas analysis. IAC use also poses potentially serious risks, including bloodstream infections and vascular complications. The purpose of this study was to assess whether IAC use was associated with mortality in patients who are mechanically ventilated and do not require vasopressor support.

Methods: This study used the Multiparameter Intelligent Monitoring in Intensive Care II database, consisting of > 24,000 patients admitted to the Beth Israel Deaconess Medical Center ICU between 2001 and 2008. Patients requiring mechanical ventilation who did not require vasopressors or have a diagnosis of sepsis were identified, and the primary outcome was 28-day mortality. A model based on patient demographics, comorbidities, vital signs, and laboratory results was developed to estimate the propensity for IAC placement. Patients were then propensity matched, and McNemar test was used to evaluate the association of IAC with 28-day mortality.

Results: We identified 1,776 patients who were mechanically ventilated who met inclusion criteria. There were no differences in the covariates included in the final propensity model between the IAC and non-IAC propensity-matched groups. For the matched cohort, there was no difference in 28-day mortality between the IAC group and the non-IAC group (14.7% vs 15.2%; OR, 0.96; 95% CI, 0.62-1.47).

Conclusions: In hemodynamically stable patients who are mechanically ventilated, the presence of an IAC is not associated with a difference in 28-day mortality. Validation in other datasets, as well as further analyses in other subgroups, is warranted.

Figures

Figure 1 –
Figure 1 –
Flowchart of patient inclusion. CSRU = cardiac surgery recovery unit; IAC = indwelling arterial catheter; MIMIC-II = Multiparameter Intelligent Monitoring in Intensive Care-II.
Figure 2 –
Figure 2 –
A-D, Propensity score distribution plot comparing non-IAC (A, C) and IAC (B, D) groups before (A, B) and after (C, D) matching. See Figure 1 legend for expansion of abbreviation.
Figure 3 –
Figure 3 –
Sensitivity analyses of various matching caliper levels. A, ORs. B, P values.

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