Evaluation of right heart catheterization in critically ill patients ONTARIO INTENSIVE CARE STUDY GROUP

OBJECTIVE: To determine physicians' assessment of the therapeutic effect and patient benefit of data obtained from right heart catheterization. DESIGN: Before/after study. SETTING: One medical and one surgical academic ICU in two medical centers. PATIENTS: A total of 107 critically ill patients with uncertain hemodynamic status. DATA COLLECTION: Physicians looking after the patients were asked to evaluate the extent to which results of right heart catheterization resulted in changes in therapy and outcome. The same questions were asked of academic intensivists, two of whom reviewed each chart. RESULTS: Agreement regarding whether right heart catheterization had changed therapy was poor (chance corrected agreement [kappas] of -0.02 to 0.33). Treating physicians were more inclined than chart reviewers to conclude that management changes based on right heart catheterization improved outcome. Agreement on which patients benefited was poor (kappas of 0.03 to 0.32). CONCLUSIONS: Physicians' assessment of the effect of right heart catheterization on treatment decisions and patient outcomes is not reliable. Credible information regarding the benefits of right heart catheterization will require randomized trials.