NATIONAL TRENDS IN THE USE OF PULMONARY CATHETER IN SEPSIS

Abstract

SESSION TITLE: Tuesday Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/22/2019 01:00 PM - 02:00 PM PURPOSE: Pulmonary artery catheter (PAC) is used to assess hemodynamic status and guide treatment in critically ill patients. There are strict guidelines for the routine use of PACs as various studies have demonstrated minimal clinical benefit. As per the recent literature, the use of PAC is increasing in heart failure. We aimed to time trend the use of PAC in sepsis using the data from the National Inpatient Sample (NIS). METHODS: We obtained data from years 2002 to 2014 using the International Classification of Diseases (ICD-9) codes for a primary diagnosis of ‘’Sepsis”. We analyzed patients older than 18 years of age and excluded the patients who underwent a right heart catheterization. We identified the PA catheter procedure by using the ICD-9 procedure codes for Pulmonary Artery (PA) Pressure monitoring, PA wedge monitoring, measurement of mixed venous blood gases, monitoring of cardiac output via Fick method and thermodilution. We assessed the time trend analysis of PA Catheter use in sepsis. We also analyzed the data to determine the trend with gender, race, length of stay (LOS), mortality and charges. SAS software was used for statistical analysis. RESULTS: The use of PAC reduced by 82% from 14.03 in 2002 to 2.55 per 1000 admission in 2010 followed by relatively stable use with a downward trend from 2011 to 2014. During the same duration, the number of patients admitted with sepsis increased by 78% from 322889 in 2002 to 1489880 in 2014. The mean age of the patients receiving PAC (PAC +) was lower (64.5 vs. 68 years, p-value <.001). PAC+ group had more prolonged hospital stay (LOS) as compared to PAC-(14.7 vs. 8.1 days) with a similar yearly trend. PAC - group showed a reduction from 8.5 days in 2002 to 7.4 days in 2014, whereas, PAC+ group showed an increase in LOS from 14.65 to 15.27 days from 2002 to 2014. PAC + group had 2.7-fold higher charges and higher in-hospital mortality score. CONCLUSIONS: Our observation indicates a gradual reduction of PAC use in sepsis. The number of patients admitted with sepsis increased significantly. The patients receiving PAC were younger, had higher in-hospital mortality score and length of stay. CLINICAL IMPLICATIONS: Older patients are usually sicker as compared to the younger population. Further studies are needed to analyze the potential reasons for higher mortality score and use of PA catheter in the younger population. DISCLOSURES: No relevant relationships by Kathir Balakumaran, source=Web Response No relevant relationships by Kai Chen, source=Web Response No relevant relationships by Manish Kumar, source=Web Response No relevant relationships by Kimberly Rebello, source=Web Response No relevant relationships by Bryan Stringer, source=Web Response No relevant relationships by Varun Tandon, source=Web Response