Document Detail


Post hoc insights from PAC-Man--the U.K. pulmonary artery catheter trial.
MedLine Citation:
PMID:  18496358     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: To provide descriptive information on patients considered for management with a pulmonary artery catheter (PAC) in U.K. intensive care units and to generate hypotheses to guide future research by examining subsets of patients included in the PAC-Man Study. DESIGN: Randomized controlled trial. SETTING: U.K. general intensive care units. PATIENTS: Adult critically ill patients deemed to require management with a PAC by the treating clinician. INTERVENTIONS: Management with a PAC. MEASUREMENTS AND MAIN RESULTS: A Cox proportional hazards model was used to estimate interactions between treatment effect and time to randomization, age, surgical status, Sequential Organ Failure Score (SOFA) at randomization, organs supported at randomization, and use of flow measurement devices. Type of hospital and size of unit were tested for an interaction with the treatment effect using multilevel logistic regression modeling. There was no effect (or trend) on hospital survival related to the timing of randomization in relation to intensive care unit admission, type of organ support or SOFA score at randomization, age, type of hospital, or size of intensive care unit. No overall difference in acute hospital outcome was seen between use of a PAC and no flow measurement (p = .748) or between use of an alternative flow measurement device and no flow measurement (p = .395). CONCLUSIONS: Post hoc analyses of the PAC-Man Study data set revealed no benefit associated with being managed with a PAC in critically ill patients. However, such analyses are limited, and adequately powered clinical trials are needed of specific population subsets receiving targeted therapies delivered early in the patient's critical illness to optimize the likelihood of reversing or preventing further organ dysfunction. Furthermore, the utility of other flow measurement devices must be investigated as these have already become integrated into critical care management without adequate evaluation.
Authors:
Sheila E Harvey; Catherine A Welch; David A Harrison; Kathryn M Rowan; Mervyn Singer
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Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Critical care medicine     Volume:  36     ISSN:  1530-0293     ISO Abbreviation:  Crit. Care Med.     Publication Date:  2008 Jun 
Date Detail:
Created Date:  2008-06-03     Completed Date:  2008-06-17     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0355501     Medline TA:  Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1714-21     Citation Subset:  AIM; IM    
Affiliation:
Medical Statistics Unit, London School of Hygiene & Tropical Medicine, London, UK. sheila.harvey@lshtm.ac.uk
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MeSH Terms
Descriptor/Qualifier:
APACHE
Aged
Cardiotonic Agents / administration & dosage
Catheterization, Swan-Ganz / statistics & numerical data*
Female
Great Britain
Health Facility Size / statistics & numerical data
Heart Failure / mortality,  therapy
Hemodynamics / drug effects
Hospital Mortality
Hospitals, University / statistics & numerical data
Humans
Intensive Care / methods*
Intensive Care Units / statistics & numerical data
Length of Stay
Male
Middle Aged
Multiple Organ Failure / mortality,  therapy*
Proportional Hazards Models
Respiratory Insufficiency / mortality,  therapy
Survival Rate
Chemical
Reg. No./Substance:
0/Cardiotonic Agents
Comments/Corrections
Comment In:
Crit Care Med. 2008 Jun;36(6):1953-4   [PMID:  18520647 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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