Reduced mortality with noninvasive hemodynamic monitoring of shock

Hata, J. Steven; Stotts, Corey; Shelsky, Constance; Bayman, Emine O.; Frazier, Anita; Wang, Jenny; Nickel, Ellen J.

doi:10.1016/j.jcrc.2010.07.001

« Previous Next »Journal of Critical Care
Volume 26, Issue 2 , Pages 224.e1-224.e8, April 2011

Reduced mortality with noninvasive hemodynamic monitoring of shock

J. Steven Hata, MD, FCCP, MSc
- Division of Critical Care in the Department of Anesthesia, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA
- Corresponding author. Division of Critical Care in the Department of Anesthesia, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA.
Corey Stotts, MD
- Anesthesiology Institute, Cleveland Clinic, Cleveland, OH 44195, USA
Constance Shelsky, RN, BSN, CCRN
- College of Pharmacy, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA
Emine O. Bayman, PhD
- The Department of Anesthesia, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA
Anita Frazier
- The Office of Clinical Quality, Safety, and Performance Improvement (CQSPI), University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA
Jenny Wang, PhD
- Department of Health Care Information, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA
Ellen J. Nickel, PharmD
- Department of Pharmacy, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA

published online 02 September 2010.

Abstract

Purpose

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.

Materials and Methods

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.

Results

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.

Conclusions

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.

Keywords: Shock, Resuscitation, Cardiac output, Pulmonary artery catheterization, Outcomes research