Variability in interventions with pulmonary artery catheter data

Abstract

Objectives: To determine if intensivists given PAC data from critically ill patients make uniform management choices. Design: Cross-sectional survey of board-certified intensivists. Setting: Medical intensive care unit. Participants: Board-certified intensivists who are members of the American College of Chest Physicians and Society of Critical Care Medicine. Interventions: A survey questionnaire containing three medical intensive care clinical vignettes was mailed to critical care physicians. Each vignette contained PAC data and one-half of the surveys contained echocardiographic (Echo) information. Every respondent was asked to select one of six interventions for each vignette. Measurements: There were 126 evaluable surveys returned. In vignette 1 an intervention (none of the above) was selected by more than 50% of respondents. In vignettes 2 and 3, the most frequent selection was chosen only 44 and 37% of the times, respectively. There was a significant difference in the distribution of management choices between the Echo and the non-Echo subgroups. Conclusions: There is significant heterogeneity in selecting an intervention based on PAC data among intensivists. The presence of Echo information may change the intervention selected but does not reduce heterogeneity. Any randomized trial evaluating efficacy of PACs will have to have strict treatment protocols.