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Update in Hospital Medicine
- Heidi L. Wald, MD; and
- Mark D. Aronson, MD
- From the University of Pennsylvania, Philadelphia, Pennsylvania; and Beth Israel Deaconess Medical Center, Boston, Massachusetts.
- Lung diseases
- Critica care
- Communicable diseases
- Terminal care
- Quality of health care
- Cardiology
- Gastroenterology
In this Update, we summarize 12 articles published during 2000 that are important to physicians who care for medical inpatients. We searched the databases of the published literature, scanned the tables of contents of major medical journals, and informally polled our colleagues to find articles that we believe will have the greatest impact on hospital medicine. The research is grouped into six categories: pulmonary and critical care, infectious diseases, end-of-life care, cardiology, gastroenterology, and health care quality. The Appendix lists other notable papers in these areas.
Pulmonary and Critical Care
Demographic Characteristics and Clinical Variables Affect Use of Pulmonary Artery Catheters
Pulmonary artery catheters were introduced in the 1970s. Despite a paucity of data from randomized trials proving their usefulness in critically ill patients, these catheters gained widespread acceptance among critical care, anesthesia, and surgical subspecialists. A 1996 observational study (1) called into question the indiscriminate use of pulmonary artery catheters, reporting worse outcomes among patients who received pulmonary artery catheters.
Rapoport and colleagues retrospectively analyzed data from 10 000 patient admissions to intensive care units (ICUs) at 27 U.S. hospitals in 1998. The authors characterized variables associated with use of pulmonary artery catheters by examining demographic characteristics, insurance status, severity of illness, and the organizational design of the ICU. Eight percent of the patients received pulmonary artery catheters. In the logistic regression analysis, after adjustment for severity of illness, age, diagnosis, and do-not-resuscitate status, patients in an ICU with “full-time” staff (that is, mandatory use of critical care physicians) were two thirds less likely to receive a pulmonary artery catheter (odds ratio, 0.36 [95% CI, 0.28 to 0.45]) compared with patients in an ICU with “part-time” staff (that is, voluntary critical care physicians). Pulmonary artery catheters were more common in white patients (odds ratio, 1.38 [CI, 1.1 to 1.72]) and in patients with private insurance coverage (odds ratio, 1.33 [CI, 1.1 to 1.6]). Surgical …
