Advertisement

Pulmonary artery occlusion pressure

  • Michael R. Pinsky
Chapter

Abstract

The bedside estimation of left ventricular (LV) performance of critically ill patients is an important aspect of the diagnosis and management of these patients. Ever since the introduction of the balloon flotation pulmonary catheterization, health care providers have used measurements of pulmonary artery occlusion pressure (Ppao) to estimate both pulmonary venous pressure and LV preload. However, the significance of any specific value for Ppao in the diagnosis and treatment of cardiovascular insufficiency in patients with diseases other than cardiogenic shock has never been validated. The reasons for this continued uncertainty reflect both intrinsic inaccuracies in the measurement of Ppao and misconceptions about their physiological significance. In this first Physiological Note we shall discuss problems in the accurate measurement of Ppao at the bedside, while in the second Physiological Note we shall discuss the physiological significance of Ppao measurements.

Keywords

Pulmonary Arterial Pressure Balloon Occlusion Left Atrial Pressure Pulmonary Artery Occlusion Pressure Pleural Pressure 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Swan HJC, Ganz W, Forrester JS, Marcus H, Diamond G, Chonette D. Catheterization of the heart in man with the use of a flow-directed balloon tipped catheter. N Engl J Med. 1970;283:447–451.PubMedCrossRefGoogle Scholar
  2. 2.
    Rajacich N, Burchard KW, Hasan FM, Singh AK. Central venous pressure and pulmonary capillary wedge pressure as estimate of left atrial pressure: effects of positive endexpiratory pressure and catheter tip malposition. Crit Care Med. 1989;17:7–11.PubMedCrossRefGoogle Scholar
  3. 3.
    Maarek J, Hakim T, Chang H. Analysis of pulmonary arterial pressure profile after occlusion of pulsatile blood flow. J Appl Physiol. 1990;68:761–769.PubMedGoogle Scholar
  4. 4.
    Teboul JL, Besbes M, Andrivet P, Besbes M, Rekik N, Lemaire F, Brun-Buisson C. A bedside index assessing the reliability of pulmonary artery occlusion pressure measurements during mechanical ventilation with positive end-expiratory pressure. J Crit Care. 1992;7:22–29.CrossRefGoogle Scholar
  5. 5.
    Hoyt JD, Leatherman JW. Interpretation of pulmonary artery occlusion pressure in mechanically ventilated patients with large respiratory excursions in intrathoracic pressure. Intensive Care Med. 1997;23:1125–1131.PubMedCrossRefGoogle Scholar
  6. 6.
    Pinsky MR, Vincent JL, DeSmet JM. Estimating left ventricular filling pressure during positive endexpiratory pressure in humans. Am Rev Respir Dis. 1991;143:25–31.PubMedGoogle Scholar
  7. 7.
    Teboul JL, Pinsky MR, Mercat A, Anguel N, Bernardin G, Achard JM, Boulain T, Richard C. Estimating cardiac filling pressure in mechanically ventilated patients with hyperinflation. Crit Care Med. 2000;28:3631–3636.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  • Michael R. Pinsky
    • 1
  1. 1.Cardiopulmonary Research Laboratory, Department of Critical Care MedicineUniversity of Pittsburgh Medical CenterPittsburghUSA

Personalised recommendations