The effectiveness of right heart catheterization in the initial care of critically ill patients. SUPPORT Investigators

摘要: Objective To examine the association between use of right heart catheterization (RHC) during first 24 hours care in intensive unit (ICU) and subsequent survival, length stay, intensity care, cost care. Design Prospective cohort study. Setting Five US teaching hospitals 1989 1994. Subjects A total 5735 critically ill adult patients receiving an ICU for 1 9 prespecified disease categories. Main outcome measures Survival time, stay hospital, determined from clinical record National Death Index. propensity score RHC was constructed using multivariable logistic regression. Case-matching regression modeling techniques were used to estimate with specific outcomes after adjusting treatment selection score. Sensitivity analysis potential effect unidentified or missing covariate on results. Results By case-matching analysis, had increased 30-day mortality (odds ratio, 1.24; 95% confidence interval, 1.03-1.49). The mean (25th, 50th, 75th percentiles) per hospital $49 300 ($17 000, $30 500, $56 600) $35 700 ($11 300, $20 600, $39 200) without RHC. Mean 14.8 (5, 9, 17) days 13.0 (4, 7, 14) These findings all confirmed by techniques. Subgroup did not reveal any patient group site which associated improved outcomes. Patients higher baseline probability surviving 2 months highest relative risk death following suggested that a would have increase 6-fold true beneficial be misrepresented as harmful. Conclusion In this observational study patients, adjustment bias, utilization resources. cause apparent lack benefit is unclear. results should other studies. justify reconsideration randomized controlled trial may guide such