Pulmonary artery catheterization in acute lung injury
Trial question
What is the role of pulmonary artery catheter-guided treatment in patients with established acute lung injury?
Study design
Multi-center
Single blinded
RCT
Population
Characteristics of study participants
46.5% female
53.5% male
N = 1000
1000 patients (465 female, 535 male).
Inclusion criteria: patients with established acute lung injury.
Key exclusion criteria: acute lung injury > 48 hours, dependence on dialysis, severe lung or neuromuscular disease, advanced cancer.
Interventions
N=513 pulmonary artery catheter-guided resuscitation.
N=487 central venous catheter-guided resuscitation.
Primary outcome
Survival at 60 days
27.4%
26.3%
27.4 %
20.5 %
13.7 %
6.8 %
0.0 %
Pulmonary artery catheter-guided
resuscitation
Central venous catheter-guided
resuscitation
No significant
difference ↔
No significant difference in survival at 60 days (27.4% vs. 26.3%; AD 1.1%, 95% CI -4.4 to 6.6).
Secondary outcomes
No significant difference in the number of ventilator free days (13.2 vs. 13.5; AD -0.3 , 95% CI -1.33 to 0.73).
Safety outcomes
No significant differences in complications-related adverse events (0.08 vs. 0.06 per catheter inserted, p=0.35).
Significant difference in arrhythmias (42 vs. 7).
Conclusion
In patients with established acute lung injury, pulmonary artery catheter-guided resuscitation was not superior to central venous catheter-guided resuscitation with respect to survival at 60 days.
Reference
National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network et al. Pulmonary-artery versus central venous catheter to guide treatment of acute lung injury. N Engl J Med. 2006 May 25;354(21):2213-24.
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