Variation in Arterial and Central Venous Catheter Use in Pediatric Intensive Care Units

Abstract

Objective: Describe patient and hospital characteristics associated with Arterial Catheter (AC) or Central Venous Catheter (CVC) use among pediatric intensive care units (ICUs). Design: Hierarchical mixed effects analyses were used to identify patient and hospital characteristics associated with AC or CVC placement. The ICU adjusted median odds ratios (ICU-AMOR) for the admission ICU, marginal R2, and conditional intraclass correlation coefficient were reported. Setting: 166 PICUs in the Virtual PICU Systems (VPS, LLC) Database. Patients: 682,791 patients with unscheduled admissions to the PICU. Intervention: None. Measures and Main Results: ACs were placed in (median, [interquartile range]) 8.2% [4.9%-11.3%] of admissions, and CVCs were placed in 14.9% [10.4%-19.3%] of admissions across cohort ICUs. Measured patient characteristics explained about 25% of the variability in AC and CVC placement. Higher Pediatric Index of Mortality 2 (PIM2) illness severity scores were associated with increased odds of placement (Odds Ratio (95th% Confidence Interval)) AC: 1.88 (1.87-1.89) and CVC: 1.82 (1.81-1.83) per 1 unit increase in PIM2 score. Primary diagnoses of cardiovascular, gastrointestinal, hematology/oncology, infectious, renal/genitourinary, rheumatology, and transplant were associated with increased odds of AC or CVC placement compared to a primary respiratory diagnosis. Presence of in-house attendings 24/7 was associated with increased odds of AC placement 1.32 (1.11-1.57). Admission ICU explained 4.9% and 3.5% of the variability in AC or CVC placement, respectively. The ICU-AMOR showed a patient would have a median increase in odds of 55% and 43% for AC or CVC placement, respectively, if the same patient moved from an ICU with lower odds of placement to an ICU with higher odds of placement. Conclusions: Variation in AC or CVC use exists among PICUs. The admission ICU was more strongly associated with AC than with CVC placement. Further study is needed to understand unexplained variation in AC and CVC use.

The end-tidal alveolar dead space fraction for risk stratification during the first week of invasive mechanical ventilation: an observational cohort study

“…Currently, there are also no validated methods for dead space calculation that do not require blood gas monitoring. While arterial blood gas monitoring practices vary between institutions, most critically ill children, even those with PARDS, are not monitored with arterial blood gases [19,20]. In critically ill adults, the ventilatory ratio has been suggested as a method to estimate dead space as this method does not require capnography data [7].…”

Risk factors for arterial catheter failure and complications during critical care hospitalisation: a secondary analysis of a multisite, randomised trial

“…International cohort studies suggest significant variation in AC use and maintenance practices-more so than with central venous catheters [19][20][21]. This variation likely stems from a lack of data regarding appropriate AC maintenance and risk factors associated with AC complications [19,20].…”