Patient Characteristics and ICU Organizational Factors That Influence Frequency of Pulmonary Artery Catheterization

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Abstract
Use of a particular technology in practice can have major clinical and economic implications. This article examines associations between clinical and demographic characteristics, organizational aspects of practice setting, type of reimbursement, and physician decisions to monitor intensive care unit (ICU) patients with the pulmonary artery catheter (PAC). Introduced in the early 1970s, PAC monitoring in the ICU increased quickly, despite the fact that its effectiveness has never been demonstrated convincingly in a sufficiently powered randomized controlled trial.1 Several studies have examined the effectiveness of the PAC in specific patient groups, with variable findings.2-4 A recent study based on a large sample of ICU patients showed that patients with a PAC had higher-than-predicted mortality, as well as higher costs and length of stay compared with patients who were not monitored with a catheter.5 The question of what is appropriate use of this technology has been considered in several consensus conferences.6,7

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