Sepsis & septic shock · Invasive monitoring in shock
Deferring Arterial Catheterization in Critically Ill Patients with Shock
| Design | Multicentre randomised non-inferiority trial |
|---|---|
| Treatment | Non-invasive strategy, deferring arterial catheter insertion |
| Control | Early arterial catheter insertion |
| Population | 1006 analysed patients with shock |
| Follow-up | 28 days |
| Primary endpoint | Death from any cause at day 28, tested for non-inferiority |
| Result | Death within 28 days occurred in 173 of 504 (34.3%) in the non-invasive-strategy group and 185 of 502 (36.9%) in the invasive-strategy group — adjusted risk difference -3.2 percentage points (95% CI -8.9 to 2.5, p=0.006 for non-inferiority). An arterial catheter was nevertheless inserted in 74 non-invasive-strategy patients (14.7%) and 493 invasive-strategy patients (98.2%). Pain or discomfort related to the monitoring device affected 13.1% versus 9.0%. |
| Secondary endpoints | Crossover to arterial catheterisation, device-related pain or discomfort, per-protocol mortality |
Among patients with shock, results for death from any cause at day 28 indicated that management without early arterial catheter insertion was noninferior to early catheter insertion.
The trial authors, in the published abstract
Another de-implementation result in a field full of reflexive invasive monitoring, alongside Hejblum 2009 for daily chest films. An arterial line remains useful in many patients; what this removes is the assumption that shock automatically requires one immediately.
Muller G, Contou D, Ehrmann S, et al. Deferring Arterial Catheterization in Critically Ill Patients with Shock. N Engl J Med 2025 Nov 13;393(19):1875-1888.