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RIGHT HEART CATHETERIZATION BENEFIT CHALLENGED.

Right heart catheterization is one of many medical interventions that is widely accepted but unproven in randomized trials. This observational study analyzed the outcomes of 5723 critically ill patients who did or did not undergo right heart catheterization during their first 24 hours in the intensive care units of five U.S. teaching hospitals. Extensive clinical data were collected as part of the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT).

Right heart catheterization was performed in 38 percent of patients during the first day; these patients had higher APACHE III scores and were more likely to have acute respiratory failure, multiorgan system failure, or congestive heart failure. Survival at 30 days was worse for those who had right heart catheterization (62 vs. 69 percent), as was six-month survival (46 vs. 54 percent). Multivariate analysis indicated that patients who underwent right heart catheterization had a 24 percent greater chance of 30-day mortality.

Comment: This study does not prove that this procedure is dangerous, since one can never be sure that all clinical differences have been taken into account. On the other hand, the benefit of right heart catheterization also remains unproven, and the call for a randomized trial is likely to intensify.

— TH Lee

Published in Journal Watch General Medicine October 1, 1996

Citation(s):

Connors AF et al. The effectiveness of right heart catheterization in the initial care of critically ill patients. JAMA 1996 Sep 18 276 889-897.

• Medline abstract (Free)