Abstract
A critical step when monitoring cardiopulmonary interactions is ensuring that measured values are accurate and precise. This chapter deals with vascular pressure measurements. These are more prone to measurement errors than respiratory pressure measurements because gas measurements are not influenced by the force of gravity. With current technologies, vascular pressures can be measured with great precision, but the “blind box” of electronic monitors also can result in artifactual values that seemingly look real. Primary goals of vascular pressure measurements are to determine the force distending vessel walls because this gives an indication of the effective volume in the system and, second, the pressure difference between compartments because this determines blood flow. When using standard fluid-filled catheters as part of the measuring system, three factors always must be considered: zeroing, leveling, and calibrating. Changes in the intrathoracic pressure surrounding the heart and blood vessels in the chest add another element that can lead to faulty interpretations of the pressures in this region. The goal of this chapter is to review these principles and to indicate some important common errors in measurement.
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References
Augustine DX, Coates-Bradshaw LD, Willis J, Harkness A, Ring L, Grapsa J, et al. Echocardiographic assessment of pulmonary hypertension: a guideline protocol from the British Society of Echocardiography. Echo Res Pract. 2018;5(3):G11–g24.
Bellemare P, Goldberg P, Magder S. Variations in pulmonary artery occlusion pressure to estimate changes in pleural pressure. Intensive Care Med. 2007;33(11):2004–8.
Bickley LS, Hoekelman RA, editors. Bates guide to physical examination and history taking. Philadelphia: Lippincott; 1999. p. 299–303.
Bytyçi I, Bajraktari G, Lindqvist P, Henein MY. Compromised left atrial function and increased size predict raised cavity pressure: a systematic review and meta-analysis. Clin Physiol Funct Imaging. 2019;39(5):297–307.
Connors AF Jr, Speroff T, Dawson NV, Thomas C, Harrell FE Jr, Wagner D, et al. The effectiveness of right heart catheterization in the initial care of critically ill patients. SUPPORT Investigators. J Am Med Assoc. 1996a;276(11):889–97.
Connors AF Jr, Speroff T, Dawson NV. The effectiveness of right heart catheterization in the initial care of critically ill patients. J Am Med Assoc. 1996b;18:1294–5.
Cournand A, Motley HL, Werko L, Richards DW Jr. Physiological studies of the effects of intermittent positive pressure breathing on cardiac output in man. Am J Physiol. 1948;152:162–74.
Courtois M, Fattal PG, Kovacs SJ, Tiefenbrunn AJ, Ludbrook PA. Anatomically and physiologically based reference level for measurement of intracardiac pressures. Circulation. 1995;92:1994–2000.
Dalen JE, Bone RC. Is it time to pull the pulmonary artery catheter? J Am Med Assoc. 1996;276(11):916–8.
Dark PM, Singer M. The validity of trans-esophageal Doppler ultrasonography as a measure of cardiac output in critically ill adults. Intensive Care Med. 2004;30(11):2060–6.
Eskesen TG, Wetterslev M, Perner A. Reanalysis of central venous pressure as an indicator of fluid responsiveness. Intensive Care Med. 2015;42:324.
Fisher CJ Jr, Dhainaut JF, Opal SM, Pribble JP, Balk RA, Slotman GJ, et al. Recombinant human interleukin 1 receptor antagonist in the treatment of patients with sepsis syndrome. Results from a randomized, double-blind, placebo-controlled trial. Phase III rhIL-1ra sepsis Syndrome Study Group. J Am Med Assoc. 1994;271(23):1836–43.
Forrester JS, Diamond G, McHugh TJ, Swan HJ. Filling pressures in the right and left sides of the heart in acute myocardial infarction. A reappraisal of central-venous-pressure monitoring. N Engl J Med. 1971;285(4):190–3.
Goldstein JA, Barzilai B, Rosamond TL, Eisenberg PR, Jaffe AS. Determinants of hemodynamic compromise with severe right ventricular infarction. Circulation. 1990;82(2):359–68.
Harvey S, Harrison DA, Singer M, Ashcroft J, Jones CM, Elbourne D, et al. 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(9484):472–7.
Iberti TJ, Fisher EP, Leibowitz AB, Panacek EA, Silverstein JH, Albertson TE. A multicenter study of physicians’ knowledge of the pulmonary artery catheter. Pulmonary artery catheter study group. J Am Med Assoc. 1990;264(22):2928–32.
Laks MM, Garner D, Swan HJ. Volumes and compliances measured simultaneously in the right and left ventricles of the dog. Circ Res. 1967;20(5):565–9.
Magder S, Bafaqeeh F. The clinical role of central venous pressure measurements. J Intensive Care Med. 2007;22(1):44–51.
Magder S, Verscheure S. Proper reading of pulmonary artery vascular pressure tracings. Am J Respir Crit Care Med. 2014;190(10):1196–8.
Magder S, Serri K, Verscheure S, Chauvin R, Goldberg P. Active expiration and the measurement of central venous pressure. J Intensive Care Med. 2016;33:430.
Mark JB. Central venous pressure monitoring: clinical insights beyond the numbers. J Cardiothorac Vasc Anesth. 1991;5(2):163–73.
McKendry M, McGloin H, Saberi D, Caudwell L, Brady AR, Singer M. Randomised controlled trial assessing the impact of a nurse delivered, flow monitored protocol for optimisation of circulatory status after cardiac surgery. BMJ. 2004;329(7460):258–0.
Moxham IM. Physics of invasive blood pressure monitoring. S Afr J Anaesth Anal. 2003;9(1):33–8.
Pinsky M, Vincent JL, De Smet JM. Estimating left ventricular filling pressure during positive end-expiratory pressure in humans. Am Rev Respir Dis. 1991;143(1):25–31.
Richard C, Warszawski J, Anguel N, Deye N, Combes A, Barnoud D, et al. Early use of the pulmonary artery catheter and outcomes in patients with shock and acute respiratory distress syndrome: a randomized controlled trial. J Am Med Assoc. 2003;290(20):2713–20.
Shapiro GG, Krovetz LJ. Damped and undamped frequency responses of underdamped catheter manometer systems. Am Heart J. 1970;80(2):226–36.
Swan HJC, Ganz W, Forrester J, Marcus H, Diamond G, Chonette D. Catheterization of the heart in man with use of a flow-directed balloon-tipped catheter. N Engl J Med. 1970;282(9):447–51.
Verscheure S, Massion PB, Gottfried S, Goldberg P, Samy L, Damas P, et al. Measurement of pleural pressure swings with a fluid-filled esophageal catheter vs pulmonary artery occlusion pressure. J Crit Care. 2016;37:65–71.
Wheeler AP, Bernard GR, Thompson BT, Schoenfeld D, Wiedemann HP, deBoisblanc B, et al. Pulmonary-artery versus central venous catheter to guide treatment of acute lung injury. N Engl J Med. 2006;354(21):2213–24.
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Magder, S. (2021). Basics of Hemodynamic Measurements. In: Magder, S., Malhotra, A., Hibbert, K.A., Hardin, C.C. (eds) Cardiopulmonary Monitoring. Springer, Cham. https://doi.org/10.1007/978-3-030-73387-2_22
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