What Conclusions Should Be Drawn between Critical Care Physician Management and Patient Mortality in the Intensive Care Unit?
Authors: Andrew A. Quartin, Roland M.H. Schein, Cynthia M. Cely
Journal: Annals of Internal Medicine (2008)

LettersNovember 18, 2008What Conclusions Should Be Drawn between Critical Care Physician Management and Patient Mortality in the Intensive Care Unit?Andrew A. Quartin, MD, MPH, Roland M.H. Schein, MD, and Cynthia M. Cely, MDAndrew A. Quartin, MD, MPHFrom University of Miami Miller School of Medicine, Miami, FL 33136., Roland M.H. Schein, MDFrom University of Miami Miller School of Medicine, Miami, FL 33136., and Cynthia M. Cely, MDFrom University of Miami Miller School of Medicine, Miami, FL 33136.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-149-10-200811180-00015 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:Levy and colleagues (1) retrospectively analyzed the Project IMPACT intensive care unit (ICU) database. They report that intensivist management was associated with increased mortality, despite adjustment for severity of illness and propensity for intensivist management. As Levy and colleagues acknowledge, their counterintuitive results contradict results of previous studies. We suspect that inadequate adjustment for confounding factors underlies these findings.Most ICU severity models, including SAPS II and MPM0-II, were derived from populations with higher mortality than that of those from Project IMPACT. Without recalibration, these models exaggerate risk for low-acuity patients. Thus, MPM0-III, developed from the same ...References1. Levy MM, Rapoport J, Lemeshow S, Chalfin DB, Phillips G, and Danis M. Association between critical care physician management and patient mortality in the intensive care unit. Ann Intern Med. 2008;148:801-9 LinkGoogle Scholar2. Higgins TL, Teres D, Copes WS, Nathanson BH, Stark M, and Kramer AA. Assessing contemporary intensive care unit outcome: an updated Mortality Probability Admission Model (MPM0-III). Crit Care Med. 2007;35:827-35. [PMID: 17255863] CrossrefMedlineGoogle Scholar3. Connors AF, Speroff T, Dawson NV, Thomas C, Harrell FE, and Wagner D; The effectiveness of right heart catheterization in the initial care of critically ill patients. SUPPORT Investigators. JAMA. 1996;276:889-97. [PMID: 8782638] CrossrefMedlineGoogle Scholar4. Harvey S, Harrison DA, Singer M, Ashcroft J, Jone CM, and Elbourne D; PAC-Man study collaboration. Assessment of the clinical effectiveness of pulmonary artery catheters in management of patients in intensive care (PAC-Man): a randomised controlled trial. Lancet. 2005;366:472-7. [PMID: 16084255] CrossrefMedlineGoogle Scholar5. National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network. Pulmonary-artery versus central venous catheter to guide treatment of acute lung injury. N Engl J Med. 2006;354:2213-24. [PMID: 16714768] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From University of Miami Miller School of Medicine, Miami, FL 33136.Disclosures: None disclosed. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoAssociation between Critical Care Physician Management and Patient Mortality in the Intensive Care Unit Mitchell M. Levy , John Rapoport , Stanley Lemeshow , Donald B. Chalfin , Gary Phillips , and Marion Danis What Conclusions Should Be Drawn between Critical Care Physician Management and Patient Mortality in the Intensive Care Unit? Michael Blumhardt What Conclusions Should Be Drawn between Critical Care Physician Management and Patient Mortality in the Intensive Care Unit? Joris J. Arends and Jan P. Vandenbroucke What Conclusions Should Be Drawn between Critical Care Physician Management and Patient Mortality in the Intensive Care Unit? 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Chalfin , and Marion Danis What Conclusions Should Be Drawn between Critical Care Physician Management and Patient Mortality in the Intensive Care Unit? Thomas L. Higgins , Brian Nathanson , and Daniel Teres Metrics November 18, 2008Volume 149, Issue 10Page: 767-768KeywordsCatheterizationDatabasesDecision makingIntensive care unitsLungsPatientsPopulation statisticsPulmonary arteriesRespiratory system procedures ePublished: 18 November 2008 Issue Published: November 18, 2008 Copyright & PermissionsCopyright © 2008 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...