Invasive Hemodynamic Monitoring With Pulmonary Artery Catheter in Sepsis-Associated Cardiogenic Shock

Abstract

Background Both sepsis-induced cardiomyopathy and worsening of pre-existing cardiac disease can contribute to circulatory shock in septic patients, The early use of pulmonary artery catheter (PAC) could play a pivotal role in the management of sepsis-associated cardiogenic shock. In this study, we aimed to evaluate the impact of early invasive hemodynamic monitoring with PAC in patients with sepsis-associated cardiogenic shock. Method We performed a retrospective study using the National Inpatient Sample data from 01/2017 to 12/2019. The early use of PAC was defined as the use of PAC within 2 days from the admission. We performed the multivariable logistic regression analysis to investigate the association between the early use of PAC and in-hospital mortality in patients with sepsis-associated cardiogenic shock and sepsis without cardiogenic shock, respectively. Results There was no difference in in-hospital mortality between PAC and No PAC groups in sepsis without cardiogenic shock (adjusted odds ratio [aOR]: 1.05, 95% confidence interval [CI]: 0.82 – 1.35, p = 691). On the other hand, the early use of PAC was independently associated with lower in-hospital mortality in patients with sepsis-associated cardiogenic shock (aOR: 0.58, 95% confidence interval [CI]: 0.46 – 0.72, p < 0.001). The use of PAC was also associated with increased use of MCS in those with sepsis-associated cardiogenic shock (aOR: 12.26, 95% CI: 9.37 – 16.03, p < 0.001). For patients with sepsis-associated cardiogenic shock, the use of PAC after 2 days of admission was associated with significantly higher in-hospital mortality and decreased use of mechanical circulatory support. Conclusion The use of pulmonary artery catheters in sepsis-associated cardiogenic shock was associated with significantly lower in-hospital mortality and increased use of mechanical circulatory supports in patients with sepsis-associated cardiogenic shock.