Investigators will conduct a pragmatic randomized trial to investigate the non-inferiority of restricted use of invasive arterial lines compared to standard arterial line use.
Patients in the medical intensive care unit (MICU) often receive arterial lines as standard of care, however there are little data to support this practice. Investigators will randomly assign consecutive weeks to either current practice(control) or to a more conservative practice of not placing invasive arterial lines except for limited indication indications as defined below (intervention). Patients entering during an intervention week will be treated according to the intervention practice throughout their ICU stay. Likewise, patients entering during a control week will be treated according to current standard practice. Permuted block randomization will be used to assure equal numbers of intervention and control weeks. All outcome measures will be obtained through EPIC data analytics and post-hospitalization phone calls. Weekly randomization codes will be generated by the study statisticians and delivered to MICU staff via sealed envelopes to be opened at the beginning of each week.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
NONE
Enrollment
700
The investigator will restrict the use of arterial catheters unless exclusion criteria is met.
The investigator will allow standard-use of arterial catheters
Dartmouth-Hitchcock Medical Center
Lebanon, New Hampshire, United States
Number of days hospitalized in the medical intensive care unit (length-of-stay)
Number of days hospitalized in the medical intensive care unit
Time frame: inpatient hospitalization (approximately 1 to 30 days)
Number of days hospitalized in a non- medical intensive care unit (Hospital length-of-stay)
Number of days hospitalized in a non- medical intensive care unit
Time frame: inpatient hospitalization (approximately 1 to 30 days)
Number of days using a mechanical ventilator (Ventilator-days)
Number of days spent on a mechanical ventilator
Time frame: inpatient hospitalization (approximately 1 to 30 days)
Number of days using vasopressor medicines (vasopressor-days)
Number of days using vasopressor medicines
Time frame: inpatient hospitalization (approximately 1 to 30 days)
Number of blood transfusions received during hospitalization (packed red blood cell transfusions)
Number of blood transfusions received during hospitalization
Time frame: inpatient hospitalization (approximately 1 to 30 days) and receiving approximately 0 - 10 blood transfusions
Number of participants experiencing a bloodstream infection related to invasive arterial catheter use
Number of participants experiencing a bloodstream infection related to invasive arterial catheter use
Time frame: inpatient hospitalization (approximately 1 to 30 days) and experiencing 0 to 1 bloodstream infections
Number of participants experiencing a vascular injury related to the invasive arterial catheter
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vascular injuries include hematoma formation, ischemic limb, false aneurysm, limb injury
Time frame: inpatient hospitalization (approximately 1 to 30 days)
Number of days subjects experiencing death within 28 days of medical intensive care unit while having received vasopressor medicines (28-day mortality while on vasopressors)
Number of days subjects experiencing death within 28 days of medical intensive care unit while having received vasopressor medicines
Time frame: Inpatient or outpatient death within 1 to 28 days
Number of days subjects experiencing death within 28 days of medical intensive care unit from any cause (28-day all-cause mortality)
Number of days subjects experiencing death within 28 days of medical intensive care unit from any cause
Time frame: Inpatient or outpatient death within 1 to 28 days
Number of days subjects experiencing death within 90 days of medical intensive care unit from any cause (90-day all-cause mortality)
The outcome of death that has occurred for subjects from all causes after 90 days
Time frame: Inpatient or outpatient death within 1 to 90 days
Number of patients experiencing renal failure while hospitalized
Renal failure is defined as any renal replacement therapy
Time frame: inpatient hospitalization (approximately 1 to 30 days)
Number of vasopressors used
The quantity of vasopressors
Time frame: Inpatient hospitalization (approximately 1 to 60 days)
Number of ABG measurements
The total quantity of ABG labs sent
Time frame: Inpatient hospitalization (approximately 1 to 60 days)