| Titre : | Patient characteristics and ICU organizational factors that influence frequency of pulmonary artery catheterization. (2000) |
| Auteurs : | J. Rapoport ; T. HIGGINS ; S. LEMESHOW ; W. MCGEE ; J. STEINGRUB ; D. TERES ; Department of Medicine and Surgery. Baystate Medical Center. Springfield. MA. USA ; Tufts University School of Medicine. Boston. MA. USA |
| Type de document : | Article |
| Dans : | JAMA - Journal of the american medical association (vol. 283, n° 19, 2000) |
| Pagination : | 2559-2567 |
| Langues: | Anglais |
| Mots-clés : | Organisation ; Pathologie ; Soins intensifs ; Homme |
| Résumé : | [BDSP. Notice produite par INIST 27R0x59U. Diffusion soumise à autorisation]. Context Hemodynamic monitoring of patients with a pulmonary artery catheter is controversial because there are few data confirming its effectiveness, and patient and intensive care unit (ICU) organizational factors associated with its use are unknown. Objective To determine pulmonary artery catheter use in relationship to type of ICU organization and staffing, and patient characteristics, including severity of illness and insurance coverage. Design, Setting, and Patients Retrospective database study of 10217 nonoperative patients who received treatment at 34 medical, mixed medical and surgical, and surgical ICUs at 27 hospitals during 1998 (patients were enrolled in Project IMPACT). Main Outcome Measures Pulmonary artery catheter use based on severity of illness measured by the Simplified Acute Physiology Score, resuscitation status at ICU admission, and ICU organizational variables, including type, size, and model. Results A pulmonary artery catheter was used for 831 patients (8.1%) in the ICU. In multivariate analysis adjusted for severity of illness, age, diagnosis, and do-not-resuscitate status, full-time ICU physician staffing was associated with a two-thirds reduction in the probability of catheter use (odds ratio [OR], 0.36 ; 95% confidence interval [Cl], 0.28-0.45). Higher catheter use was associated with white race (OR, 1.38 ; 95% Cl, 1.10-1.72) and private insurance coverage (OR, 1.33 ; 95% Cl, 1.10-1.60). (...) |
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