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Pulmonary-artery versus central venous catheter to guide treatment of acute lung injury.
N Engl J Med. 2006 May 25; 354(21):2213-24.NEJM

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.).

Authors+Show Affiliations

Vanderbilt University, Nashville, USA. art.wheeler@vanderbilt.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

16714768

Citation

National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network, et al. "Pulmonary-artery Versus Central Venous Catheter to Guide Treatment of Acute Lung Injury." The New England Journal of Medicine, vol. 354, no. 21, 2006, pp. 2213-24.
National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network, Wheeler AP, Bernard GR, et al. Pulmonary-artery versus central venous catheter to guide treatment of acute lung injury. N Engl J Med. 2006;354(21):2213-24.
Wheeler, A. P., Bernard, G. R., Thompson, B. T., Schoenfeld, D., Wiedemann, H. P., deBoisblanc, B., Connors, A. F., Hite, R. D., & Harabin, A. L. (2006). Pulmonary-artery versus central venous catheter to guide treatment of acute lung injury. The New England Journal of Medicine, 354(21), 2213-24.
National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network, et al. Pulmonary-artery Versus Central Venous Catheter to Guide Treatment of Acute Lung Injury. N Engl J Med. 2006 May 25;354(21):2213-24. PubMed PMID: 16714768.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Pulmonary-artery versus central venous catheter to guide treatment of acute lung injury. AU - ,, AU - Wheeler,Arthur P, AU - Bernard,Gordon R, AU - Thompson,B Taylor, AU - Schoenfeld,David, AU - Wiedemann,Herbert P, AU - deBoisblanc,Ben, AU - Connors,Alfred F,Jr AU - Hite,R Duncan, AU - Harabin,Andrea L, Y1 - 2006/05/21/ PY - 2006/5/23/pubmed PY - 2006/6/2/medline PY - 2006/5/23/entrez SP - 2213 EP - 24 JF - The New England journal of medicine JO - N. Engl. J. Med. VL - 354 IS - 21 N2 - 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.). SN - 1533-4406 UR - https://www.unboundmedicine.com/medline/citation/16714768/Pulmonary_artery_versus_central_venous_catheter_to_guide_treatment_of_acute_lung_injury_ L2 - http://www.nejm.org/doi/full/10.1056/NEJMoa061895?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -