CHEST Guidelines-Arterial-Lines-in-the-ICU

Arterial-Lines-in-the-ICU_chest

Pdf Summary

The document discusses the appropriateness and justification for using medical interventions within intensive care units (ICUs), specifically focusing on indwelling arterial catheters (ACs). Despite being widely used for blood pressure (BP) monitoring and blood sampling, there is no substantial evidence proving their benefits over non-invasive methods. The text argues that ACs pose complications such as bloodstream infections and arterial thrombosis, yet are still commonly used due to tradition and lack of critical evaluation by medical professionals.<br /><br />The main body elaborates on the ineffective but physiologically reasonable use of various ICU interventions that had historical precedence, citing examples like nesiritide for heart failure and hyperventilation for brain injury, only to later be proven ineffectual or harmful. Similarly, ACs have been adopted extensively without rigorous scientific backing, largely due to their perceived accuracy in BP measurement, although automated noninvasive measurements are standard in outpatient settings and can be similarly plagued by inaccuracies.<br /><br />The author, Allan Garland, calls for high-quality randomized trials to determine the actual impact of ACs on patient outcomes, highlighting the necessity of examining different patient subgroups and relevant criteria such as mortality, comfort, complications, and costs. In particular, a study examining almost 11,000 patients indicated a higher mortality rate among those administered ACs for vasopressor-needed shock, suggesting potential adverse outcomes from their use.<br /><br />Despite their purported advantages, AC usage also leads to increased testing and resultant complications like anemia, which necessitates further exploration into the consequences of their prevalent use. In conclusion, Garland emphasizes that clinical practices should be evidence-based rather than grounded in historical or expert opinion, advocating for a reassessment of common interventions to prevent any underlying harm they may pose to patients.

Keywords

intensive care units

indwelling arterial catheters

blood pressure monitoring

bloodstream infections

arterial thrombosis

non-invasive methods

randomized trials

patient outcomes

clinical practices

evidence-based medicine