Relationship of Pulmonary Artery Catheter Use to Mortality
Objective: To examine the relationship of pulmonary artery catheter (PAC) use to patient outcomes, including mortality rate and resource utilization, in patients with severe sepsis in eight academic medical centers.
Design: Case-control, nested within a prospective cohort study.
Setting: Eight academic tertiary care centers.
Patients: Stratified random sample of 1,010 adult admissions with severe sepsis.
Interventions: None.
Measurements and Main Results: The main outcome measures were in-hospital mortality, total hospital charge, and length of stay (LOS) for patients with and without PAC use. The case-matched subset of patients included 141 pairs managed with and without the use of a PAC. The mortality rate was slightly but not statistically significantly lower among the PAC use group compared with those not using a PAC (41.1% vs. 46.8%, p = .34). Even this trend disappeared after we adjusted for the Charlson comorbidity score and sepsis-specific Acute Physiology and Chronic Health Evaluation (APACHE) III (adjusted odds ratio, 1.02; 95% confidence interval, 0.61-1.72). In linear regression models adjusted for the Charlson comorbidity score, sepsis-specific APACHE III, surgical status, receipt of a steroid before sepsis onset, presence of a Hickman catheter, and preonset LOS, no significant differences were found for total hospital charges (US$139,207 vs. 148,190, adjusted mean comparing PAC and non-PAC group, p = .57), postonset LOS (23.4 vs. 26.9 days, adjusted mean, p = .32), or total LOS in intensive care unit (18.2 vs. 18.8 days, adjusted mean, p = .82).
Conclusions: Among patients with severe sepsis, PAC placement was not associated with a change in mortality rate or resource utilization, although small nonsignificant trends toward lower resource utilization were present in the PAC group.

Severe sepsis is a common and serious condition among critically ill patients. Despite advances in diagnostic and therapeutic intervention, the mortality rate associated with sepsis remains high, especially among those who develop hemodynamic shock and/or organ dysfunction. For supportive care in patients with septic shock, a pulmonary artery catheter (PAC) frequently is used for hemodynamic monitoring, even though the effect of PAC use on improvement of patient outcomes is controversial.

The use of PACs is perhaps most helpful when right- and left-sided cardiac function is different, as in cardiac illnesses, although PACs also may be helpful in optimizing variables in severe sepsis. Some data from large observational studies suggested that PACs are associated with higher resource use and even with higher mortality rate.

To address whether PAC use was associated with mortality rate or resource use in patients with severe sepsis, we performed a study in eight academic medical centers and used propensity scores to adjust for confounding by indication for receiving a PAC.