Incidence and efficacy of pulmonary artery catheters in the ICU of a developing country: a prospective, controlled study

Background

Existing randomized controlled trials on pulmonary artery catheter (PAC)-guided strategies reveal a modest risk reduction that does reach statistical significance. Risk reduction appears to be greatest in surgical series. This is primarily inserted for patients with systemic shock requiring haemodynamic support. However the efficacy of data collected from its use and the cost-benefit ratio are debatable. We would like to propose a study to look at the following objectives in the setting of a Third-World country ICU.

Objectives

The incidence, indications, complication rate and outcome of PAC use in our ICU over a period of 3 months, comparing cases with matched controls.

Design

An observational, prospective, controlled study in the ICU of a tertiary care university hospital serving an urban population of a Third-World country with limited resources.

Methods

Over a period of 3 months every patient admitted to the ICU who had a PAC inserted for any indication was included. An equal number of patients matched for age and diagnosis but without a PAC were used as controls. Sample size calculation: as we do not have an incidence of PAC use available for our ICU as yet, a sample size calculation was not possible; however, we propose to study the incidence as well as indications and outcome by carrying out this study over 3 months. Data collection was carried out by the first author and an ICU resident. The data were collected by means of a data collection form.

Results and conclusion

Fourteen patients and controls were enrolled in the study. The incidence of PAC use was 19% of all ICU admissions. Statistical analysis using Fisher's exact test and Student's t test revealed a P value of 0.677 for outcome with a nonsignificant difference between the two groups; a P value of 0.003 for length of stay, proving a significant difference between the two groups; and a P value of 0.455 (nonsignificant) for the mean age of patients with PACs. Pneumonia and sepsis were two of the leading causes for ICU admission; while 'fluid management' and 'haemodynamic monitoring' were two leading indications for PAC insertion. There were complications present in 30% of the patients, including line sepsis, balloon rupture and coiling. Cost analysis showed a total cost of Rs.16,532/per patient for PAC insertion and monitoring. Despite being a limited study, we can clearly see that the cost effectiveness and outcome of patients with the PAC seems ambiguous. In a developing country where resources are limited, thought must be given to the risk and benefit ratio of placing this invasive monitor and the use of the information provided properly justified.