Utilization Patterns and Outcomes Associated with Central Venous Catheter in Septic Shock: a Population-based Study

Overview

Journal Crit Care Med

Specialties Critical Care
Emergency Medicine

Date 2013 Mar 20

PMID 23507718

Citations 44

Authors

Allan J Walkey

Renda Soylemez Wiener

Peter K Lindenauer

Affiliations

Soon will be listed here.

Abstract

Objectives: In 2001, a randomized trial showed decreased mortality with early, goal-directed therapy in septic shock, a strategy later recommended by the Surviving Sepsis Campaign. Placement of a central venous catheter is necessary to administer goal-directed therapy. We sought to evaluate nationwide trends in: 1) central venous catheter utilization and 2) the association between early central venous catheter insertion and mortality in patients with septic shock.

Design: We retrospectively analyzed the proportion of septic shock cases receiving an early (day of admission) central venous catheter and the odds of hospital mortality associated with receiving early central venous catheter from years 1998 to 2001 compared with 2002 to 2009.

Setting: Non-federal acute care hospitalizations from the Nationwide Inpatient Sample, 1998-2009.

Patients: A total of 203,481 (population estimate: 999,545) patients admitted through an emergency department with principal diagnosis of septicemia and secondary diagnosis of shock.

Interventions: None.

Measurements And Main Results: From 1998 to 2009, population-adjusted rates of septic shock increased from 12.6 cases per 100,000 U.S. adults to 78 cases per 100,000. During this time, age-adjusted hospital mortality associated with septic shock declined from 40.4% to 31.4%. Early central venous catheter insertion increased from 5.7% (95% confidence interval 5.1% to 6.3%) to 19.2% (95% confidence interval 18.7% to 19.5%) cases with septic shock, with an increased rate of early central venous catheter placement identified after 2007. The rate of decline in age-adjusted hospital mortality was significantly greater for patients who received an early central venous catheter (-4.2% per year, 95% confidence interval -3.2, -4.2%) as compared with no central venous catheter (-2.9% per year, 95% confidence interval -2.3, -3.5%; p = 0.016). Hospital mortality associated with early central venous catheter insertion significantly decreased from a multivariable-adjusted odds ratio of 1.29 (95% confidence interval 1.14-1.45) prior to 2001 to an adjusted odds ratio of 0.87 (95% confidence interval 0.84-0.90) after 2001.

Conclusions: Placement of a central venous catheter early in septic shock has increased three-fold since 1998. The mortality associated with early central venous catheter insertion decreased after publication of evidence-based instructions for central venous catheter use.

Citing Articles

The Study of the Feasibility of Ultrasound-guided Catheterization of the Right Brachiocephalic Vein in Adult Patients: A Prospective Observational Study.

Singh Y, Pratibhan M, Singh A, Depal V, Sawhney C, Gupta B J Med Ultrasound. 2024; 32(2):143-147.

PMID: 38882630 PMC: 11175376. DOI: 10.4103/jmu.jmu_57_23.

Unpacking Regionalization of Sepsis Care Using Hospital Capability Assessments.

Anesi G, Admon A Crit Care Med. 2023; 51(11):1594-1596.

PMID: 37902344 PMC: 10617649. DOI: 10.1097/CCM.0000000000005987.

Are patient volume and care level in teaching hospitals variables affecting clinical outcomes in adult intensive care units?.

Teixeira R, Oliveira J, Andrade M, Pinheiro F, Vieira R, Santana-Santos E Einstein (Sao Paulo). 2023; 21:eAO0406.

PMID: 37820201 PMC: 10519666. DOI: 10.31744/einstein_journal/2023AO0406.

CD19CD24CD38 regulatory B cells deficiency revealed severity and poor prognosis in patients with sepsis.

Wang C, Xu H, Gao R, Leng F, Huo F, Li Y BMC Immunol. 2022; 23(1):54.

PMID: 36357845 PMC: 9648441. DOI: 10.1186/s12865-022-00528-x.

Optimization of sepsis therapy based on patient-specific digital precision diagnostics using next generation sequencing (DigiSep-Trial)-study protocol for a randomized, controlled, interventional, open-label, multicenter trial.

Brenner T, Skarabis A, Stevens P, Axnick J, Haug P, Grumaz S Trials. 2021; 22(1):714.

PMID: 34663439 PMC: 8522064. DOI: 10.1186/s13063-021-05667-x.

References

Lindenauer P, Lagu T, Shieh M, Pekow P, Rothberg M . Association of diagnostic coding with trends in hospitalizations and mortality of patients with pneumonia, 2003-2009. JAMA. 2012; 307(13):1405-13. DOI: 10.1001/jama.2012.384. View

Lagu T, Rothberg M, Shieh M, Pekow P, Steingrub J, Lindenauer P . What is the best method for estimating the burden of severe sepsis in the United States?. J Crit Care. 2012; 27(4):414.e1-9. DOI: 10.1016/j.jcrc.2012.02.004. View

Suissa S . Effectiveness of inhaled corticosteroids in chronic obstructive pulmonary disease: immortal time bias in observational studies. Am J Respir Crit Care Med. 2003; 168(1):49-53. DOI: 10.1164/rccm.200210-1231OC. View

Wiener R, Welch H . Trends in the use of the pulmonary artery catheter in the United States, 1993-2004. JAMA. 2007; 298(4):423-9. DOI: 10.1001/jama.298.4.423. View

Bone R, Balk R, Cerra F, Dellinger R, Fein A, Knaus W . Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest. 1992; 101(6):1644-55. DOI: 10.1378/chest.101.6.1644. View

Kumar G, Kumar N, Taneja A, Kaleekal T, Tarima S, McGinley E . Nationwide trends of severe sepsis in the 21st century (2000-2007). Chest. 2011; 140(5):1223-1231. DOI: 10.1378/chest.11-0352. View

Dellinger R, Carlet J, Masur H, Gerlach H, Calandra T, Cohen J . Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock. Crit Care Med. 2004; 32(3):858-73. DOI: 10.1097/01.ccm.0000117317.18092.e4. View

Connors Jr A, Speroff T, Dawson N, Thomas C, Harrell Jr F, Wagner D . The effectiveness of right heart catheterization in the initial care of critically ill patients. SUPPORT Investigators. JAMA. 1996; 276(11):889-97. DOI: 10.1001/jama.276.11.889. View

Krumholz H, Chen J, Rathore S, Wang Y, Radford M . Regional variation in the treatment and outcomes of myocardial infarction: investigating New England's advantage. Am Heart J. 2003; 146(2):242-9. DOI: 10.1016/S0002-8703(03)00237-0. View

10.

Dombrovskiy V, Martin A, Sunderram J, Paz H . Rapid increase in hospitalization and mortality rates for severe sepsis in the United States: a trend analysis from 1993 to 2003. Crit Care Med. 2007; 35(5):1244-50. DOI: 10.1097/01.CCM.0000261890.41311.E9. View

11.

Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B . Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med. 2002; 345(19):1368-77. DOI: 10.1056/NEJMoa010307. View

12.

Reade M, Huang D, Bell D, Coats T, Cross A, Moran J . Variability in management of early severe sepsis. Emerg Med J. 2010; 27(2):110-5. DOI: 10.1136/emj.2008.070912. View

13.

Allison J, Kiefe C, Weissman N, Person S, Rousculp M, Canto J . Relationship of hospital teaching status with quality of care and mortality for Medicare patients with acute MI. JAMA. 2000; 284(10):1256-62. DOI: 10.1001/jama.284.10.1256. View

14.

Angus D, Lidicker J, Clermont G, Carcillo J, Pinsky M . Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med. 2001; 29(7):1303-10. DOI: 10.1097/00003246-200107000-00002. View

15.

Hall W, Willis L, Medvedev S, Carson S . The implications of long-term acute care hospital transfer practices for measures of in-hospital mortality and length of stay. Am J Respir Crit Care Med. 2011; 185(1):53-7. PMC: 3361349. DOI: 10.1164/rccm.201106-1084OC. View

16.

Quan H, Parsons G, Ghali W . Validity of procedure codes in International Classification of Diseases, 9th revision, clinical modification administrative data. Med Care. 2004; 42(8):801-9. DOI: 10.1097/01.mlr.0000132391.59713.0d. View

17.

Wheeler A, Bernard G, Thompson B, Schoenfeld D, Wiedemann H, deBoisblanc B . Pulmonary-artery versus central venous catheter to guide treatment of acute lung injury. N Engl J Med. 2006; 354(21):2213-24. DOI: 10.1056/NEJMoa061895. View

18.

Harvey S, Harrison D, Singer M, Ashcroft J, Jones C, Elbourne D . Assessment of the clinical effectiveness of pulmonary artery catheters in management of patients in intensive care (PAC-Man): a randomised controlled trial. Lancet. 2005; 366(9484):472-7. DOI: 10.1016/S0140-6736(05)67061-4. View

19.

Weiss C, Moazed F, McEvoy C, Singer B, Szleifer I, Amaral L . Prompting physicians to address a daily checklist and process of care and clinical outcomes: a single-site study. Am J Respir Crit Care Med. 2011; 184(6):680-6. PMC: 3208596. DOI: 10.1164/rccm.201101-0037OC. View

20.

Rethans J, Sturmans F, Drop R, van der Vleuten C, Hobus P . Does competence of general practitioners predict their performance? Comparison between examination setting and actual practice. BMJ. 1991; 303(6814):1377-80. PMC: 1671632. DOI: 10.1136/bmj.303.6814.1377. View