Variability in interventions with pulmonary artery catheter data

Jain, Manu; Canham, Michelle L.; Upadhyay, Daya; Corbridge, Thomas C.

doi:10.1007/s00134-003-1924-7

Cited by 43 publications

(23 citation statements)

References 18 publications

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“…This finding led some to recommend re-evaluation of current accreditation and teaching practices (535)(536)(537)(538). The American Society of Anesthesiologists Task Force on Pulmonary Artery Catheterization has recently provided an update to the practice guidelines for pulmonary artery catheterization (526).…”

Section: Perioperative Surveillancementioning

confidence: 98%

2009 ACCF/AHA Focused Update on Perioperative Beta Blockade Incorporated Into the ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery

Fleisher¹,

Beckman²,

Brown³

et al. 2009

Journal of the American College of Cardiology

337

240

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Section: Perioperative Surveillancementioning

confidence: 98%

2009 ACCF/AHA Focused Update on Perioperative Beta Blockade Incorporated Into the ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery

Fleisher¹,

Beckman²,

Brown³

et al. 2009

Journal of the American College of Cardiology

337

240

View full text Add to dashboard Cite

“…Moreover, vignettes with hypothetical cases have been used in the critical care literature to understand physician behavior. 31,32 Our vignettes were from real patients, and the outcome of interest was known to us.…”

Section: Discussionmentioning

confidence: 99%

Accuracy and Reliability of Extubation Decisions by Intensivists

Tulaimat

Mokhlesi

2011

Respir Care

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BACKGROUND: Mortality increases when extubations fail. Although predictors of extubation failure have been evaluated, physicians' reasoning to extubate a patient has received minimal attention. We hypothesized that the accuracy and reliability of physicians' extubation decisions are low. METHODS: We sent surveys to 55 physicians in the divisions of pulmonary and critical care medicine of 3 teaching hospitals in Chicago, Illinois. The survey comprised 32 clinical vignettes of real patients who were extubated after they tolerated a spontaneous breathing trial (16 failed extubations). Unaware of the outcomes of extubation, the physicians were asked if they would extubate each patient, and to give reasons if they opted not to. We quantified the agreement between and accuracy of the physicians' decisions, determined the patient characteristics that influence the extubation decision, and described the tradeoffs leading to that decision. RESULTS: Completed surveys were obtained from 45 physicians (82%). The physicians postponed extubation in 37% of the cases. Agreement between any 2 physicians was fair (mean ؎ SD phi 0.34 ؎ 0.15) and was highest between attending physicians from the same institution (0.37 ؎ 0.15). In deciding to extubate a patient, 33% of the physicians relied on the breathing pattern on pressure support ventilation, 49% relied on the acid-base status, 13% relied on the mental status, and 8% relied on the amount of secretions. The accuracy of the physicians' extubation decisions was low (area under the receiver operating characteristic curve 0.35). The sensitivity of the physicians identifying the patients who were successfully extubated was 57%, and the specificity was 31%. A model that comprises the same variables that influenced the physicians was more accurate in predicting extubation outcome (area under the receiver operating characteristic curve 0.88). CONCLUSIONS: For a decision made on an almost daily basis in intensive care units, physicians' extubation decisions are inaccurate and only fairly reliable.

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“…One factor may be the inability of many physicians to adequately interpret the data obtained with this device [16,17], resulting in inadequate decisions. Interestingly, the addition of echocardiographic data does not necessarily improve the interpretation of the respondents [18], suggesting that the physicians are more in fault than the technique [19]. Another factor is that the patients included in these trials were highly selected.…”

Section: Advanced Hemodynamic Monitoringmentioning

confidence: 97%

Is There a Role for Invasive Hemodynamic Monitoring in Acute Heart Failure Management?

Backer

2015

Curr Heart Fail Rep

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The place of invasive hemodynamic monitoring in patients with acute heart failure is still debated, even though frequently used. Invasive techniques, which include the pulmonary artery catheter and transpulmonary thermodilution, provide important information on cardiac output and intravascular pressures or volume. These techniques should be used in combination with echocardiography and allow nurse-driven semicontinuous hemodynamic monitoring. These techniques are useful not only in the diagnosis of circulatory or respiratory failure but also for the evaluation of the effects of therapies. Admittedly, large-scale randomized trials failed to demonstrate a survival benefit with the pulmonary artery catheter (and were even not yet performed with transpulmonary thermodilution). However, these trials may be subjected to selection bias, as patients from recruiting centers not included in the trial but receiving the pulmonary artery catheter were more severe and had higher mortality rates than patient included in the trial. Hence, invasive techniques may still have a place in selected patients with acute circulatory failure and especially in the most severe cases.

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Variability in interventions with pulmonary artery catheter data

Cited by 43 publications

References 18 publications

2009 ACCF/AHA Focused Update on Perioperative Beta Blockade Incorporated Into the ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery

2009 ACCF/AHA Focused Update on Perioperative Beta Blockade Incorporated Into the ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery

Accuracy and Reliability of Extubation Decisions by Intensivists

Is There a Role for Invasive Hemodynamic Monitoring in Acute Heart Failure Management?

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