Journal article
Reduced mortality with noninvasive hemodynamic monitoring of shock
Journal of critical care, Vol.26(2), pp.224.e1-224.e8
2011
DOI: 10.1016/j.jcrc.2010.07.001
PMID: 20813490
Abstract
This study compared clinical outcomes associated with exposure to pulmonary artery catheters (PACs), central venous catheters (CVCs), arterial pressure waveform analysis for cardiac output (APCO), or no central monitoring (NCM) in patients with shock.
We assessed 6929 consecutive patients from 2003 to 2006 within a surgical intensive care unit of a university hospital, identifying 237 mechanically ventilated patients with shock.
Adjusted for severity of illness, use of APCO monitoring, compared with other options, was associated with reduced intensive care unit mortality (odds ratio [OR], 0.37; 95% confidence interval [CI], 0.18-0.77) and 28-day mortality (OR, 0.43; 95% CI, 0.22-0.85). Other monitors were not associated with changes of 28-day mortality (CVC: OR, 0.63; 95% CI, 0.34-1.17; PAC: OR, 0.78; 95% CI, 0.36-1.69) or were associated with increased risk (NCM: OR, 2.29; 95% CI, 1.14-4.61). There were significant differences in the fluid and vasoactive drug prescriptions among the groups.
This study supports an association between the use of APCO monitoring and reduction in mortality in shock compared with traditional methods of monitoring. Although it is impossible to exclude the role of unrecognized/unrecorded differences among the groups, these findings may result from differences in supportive care, directed by monitor technology.
Details
- Title: Subtitle
- Reduced mortality with noninvasive hemodynamic monitoring of shock
- Creators
- J. Steven Hata - Division of Critical Care in the Department of Anesthesia, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USACorey Stotts - Anesthesiology Institute, Cleveland Clinic, Cleveland, OH 44195, USAConstance Shelsky - College of Pharmacy, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USAEmine O Bayman - The Department of Anesthesia, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USAAnita Frazier - The Office of Clinical Quality, Safety, and Performance Improvement (CQSPI), University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USAJenny Wang - Department of Health Care Information, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USAEllen J Nickel - Department of Pharmacy, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA
- Resource Type
- Journal article
- Publication Details
- Journal of critical care, Vol.26(2), pp.224.e1-224.e8
- Publisher
- Elsevier Inc
- DOI
- 10.1016/j.jcrc.2010.07.001
- PMID
- 20813490
- ISSN
- 0883-9441
- eISSN
- 1557-8615
- Language
- English
- Date published
- 2011
- Academic Unit
- Biostatistics; Anesthesia
- Record Identifier
- 9983997318302771
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