RELATIONSHIP BETWEEN PULMONARY ARTERY PRESSURE (PAP) OR PULMONARY “CAPILLARY WEDGE” PRESSURE (PCWP) AND CARDIOGENIC GAS FLOW OSCILLATIONS (CGFO)

1983 ◽  
Vol 11 (3) ◽  
pp. 245
Author(s):  
Julio C. Cruz ◽  
Ingvar Sodal ◽  
Dean R. Dobbert ◽  
Jerritt Hansell ◽  
Roger Dzwonezyk
Keyword(s):  
Pulmonary Artery ◽  
Pulmonary Capillary Wedge Pressure ◽  
Pulmonary Artery Pressure ◽  
Gas Flow ◽  
Artery Pressure ◽  
Pulmonary Capillary ◽  
Flow Oscillations ◽  
Wedge Pressure

Reliability of measurements of pulmonary artery pressure obtained with patients in the 60 degrees lateral position

2000 ◽  
Vol 9 (1) ◽  
pp. 43-51 ◽  
Author(s):  
LM Aitken
Keyword(s):  
Pulmonary Artery ◽  
Pulmonary Capillary Wedge Pressure ◽  
Pulmonary Artery Pressure ◽  
General Medicine ◽  
Lateral Position ◽  
Artery Pressure ◽  
Pulmonary Capillary ◽  
Quasi Experimental ◽  
The Right ◽  
Wedge Pressure

BACKGROUND: Monitoring of pulmonary artery pressure is an essential component of the care of critically ill patients. The conditions under which reliable measurements can be obtained must be clarified. OBJECTIVES: To determine (1) whether reliable measurements of pulmonary artery pressure can be obtained with patients in the right or left 60 degrees lateral position and (2) which characteristics of patients preclude obtaining reliable measurements. METHODS: One hundred five patients (65 cardiac surgery, 40 general medicine) with pulmonary artery catheters were enrolled in a prospective, stratified, quasi-experimental study. Subjects were repositioned from supine (head of bed elevated < 30 degrees with 1 pillow) to the left and right 60 degrees lateral positions. Systolic, diastolic, and mean pulmonary artery pressures and pulmonary capillary wedge pressure were measured before and 5, 10, and 20 minutes after lateral repositioning. The zero reference was the phlebostatic axis when patients were supine and the dependent midclavicular line at the level of the fourth intercostal space when patients were in the lateral positions. RESULTS: In most patients, measurements obtained with patients in the lateral position differed significantly from measurements obtained with patients supine. None of the variables examined were reliable predictors of which patients would have these differences. More than 11% of the patients had clinically significant differences in addition to the statistically significant differences. CONCLUSION: Reliable measurements of pulmonary artery pressure and pulmonary capillary wedge pressure cannot be obtained with patients in the 60 degrees lateral position.

scholarly journals P1429 B-Type natriuretic peptide prediction of right catheterization parameters in the first year after heart transplant

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
A A Valentim Goncalves ◽  
T Pereira-Da-Silva ◽  
R Soares ◽  
L De Sousa ◽  
R Ilhao Moreira ◽  
...  
Keyword(s):  
Cardiac Index ◽  
Pulmonary Artery ◽  
Pulmonary Capillary Wedge Pressure ◽  
Pulmonary Vascular Resistance ◽  
Natriuretic Peptide ◽  
Pulmonary Artery Pressure ◽  
Right Atrial ◽  
First Year ◽  
Pulmonary Capillary ◽  
Wedge Pressure

Abstract Introduction Despite being the gold-standard for hemodynamic assessment, right heart catheterization (RHC) was overcome by plasma B-Type Natriuretic Peptide (BNP) levels in daily clinical routine. However, in the first year after heart transplantation (HT), the relationship between BNP and adverse hemodynamics have yielded conflicting results. Purpose The aim of this study was to evaluate whether BNP values can be used to estimate adverse hemodynamics in the first year after HT. Methods Prospective study of consecutive RHC performed in the first year after HT (according to the endomyocardial biopsies program). Plasma BNP levels were measured at the same day. The area under the curve (AUC) was analysed to find the BNP values with higher sensitivity and specificity to detect adverse hemodynamics. Results From 2017 to 2018, 50 RHC were performed. Mean age was 48.7 ± 8.3 years, with mean BNP value of 964.4 ± 1114.7pg/ml. Prediction of adverse hemodynamics by AUC results are represented in the table. BNP values were significantly increased in patients with pulmonary capillary wedge pressure (PCWP) >12mmHg (p < 0.001), cardiac index <2.5L/min/m2 (p = 0.001), mean pulmonary artery pressure (mPAP) ≥25mmHg (p < 0.001), pulmonary vascular resistance > 1,5WU (p = 0.044) and right atrial pressure >5mmHg (p = 0.003). BNP >500pg/ml had a sensitivity of 78.3% and 87.5% and a specificity of 76.0% and 67.7% to detect PCWP >12mmHg and mPAP ≥25mmHg, respectively. Conclusion Significant associations were found between BNP values and adverse hemodynamics in RHC, supporting the clinical utility of BNP in the first year after HT. BNP prediction AUC values SR HEMODYNAMIC PARAMETERS AUC p 95% CI Best BNP value Sensitivity Specificity Pulmonary capillary wedge pressure (PCWP) > 12mmHg 0.798 <0.001 0.671-0.925 > 500pg/ml 78.3% 76.0% Mean pulmonary artery pressure (mPAP) ≥ 25mmHg 0.830 <0.001 0.714-0.946 > 500pg/ml 87.5% 67.7% Cardiac output < 4L/min 0.833 0.002 0.667-1.000 > 1500pg/ml 77.8% 87.5% Cardiac index (CI) < 2.5L/min/m2 0.810 0.001 0.663-0.957 > 1150pg/ml 76.9% 86.1% Pulmonary vascular resistance (PVR) > 1,5WU 0.678 0.044 0.509-0.848 > 200pg/ml 83.3% 47.1% Right atrial pressure (RAP) > 5mmHg 0.744 0.003 0.607-0.880 > 500pg/ml 70.8% 65.4% BNP prediction

Effect of repeated exercise on the lesser circulation

1963 ◽  
Vol 18 (5) ◽  
pp. 983-986 ◽  
Author(s):  
Jiri Widimsky ◽  
Erik Berglund ◽  
Rolf Malmberg
Keyword(s):  
Pulmonary Artery ◽  
Lung Disease ◽  
Pulmonary Artery Pressure ◽  
Healthy Subjects ◽  
Artery Pressure ◽  
Repeated Exercise ◽  
Exercise Period ◽  
Pulmonary Arterial ◽  
Lung Vessels ◽  
Wedge Pressure

In four healthy subjects and four patients with lung disease, hemodynamic studies were done during two periods of identical exercise, 1 hr apart. Pulmonary artery pressure was lower in the second exercise period in all subjects studied. Pulmonary arterial wedge pressure was measured in four cases and was unchanged or even slightly increased. The “total pulmonary” and pulmonary vascular resistances were markedly lower in the second exercise period. The decrease in pulmonary artery pressure was found also in the second postexercise period when compared with the starting resting level. It is believed that this fall in pulmonary artery pressure and resistance was due to opening or widening of previously closed or constricted lung vessels. Repeated exercise must be used with caution when studying the effect of pharmacological or physiological agents on the lesser circulation. Submitted on November 30, 1962

Effects of altered left atrial pressure on pulmonary vascular pressure-flow relationships

1988 ◽  
Vol 255 (1) ◽  
pp. H19-H25 ◽  
Author(s):  
J. Ducas ◽  
U. Schick ◽  
L. Girling ◽  
R. M. Prewitt
Keyword(s):  
Pulmonary Artery ◽  
Pulmonary Artery Pressure ◽  
Pulmonary Vasculature ◽  
Pressure Flow ◽  
Artery Pressure ◽  
Time Control ◽  
Pulmonary Capillary ◽  
Anesthetized Dogs ◽  
Group 2 ◽  
Group 1

We studied the effects of changes in pulmonary capillary wedge pressure (PCWP) on the slope (incremental resistance) and the extrapolated pressure intercept (PI) of the mean pulmonary artery pressure (PAP)-cardiac output (CO) relationship. Multipoint plots of PAP against CO were obtained in intact anesthetized dogs. Group 1 consisted of six dogs entirely in West zone 3 and group 2 of four dogs with mixed West zone 2-3. The four conditions studied were the following: 1) fixed low PCWP, 2) fixed high PCWP, 3) variable PCWP, and 4) time-control repeat of condition 1. The PI significantly exceeded PCWP at fixed low PCWP (group 1, 9.3 vs. 11.1 mmHg, group 2, 6.6 vs. 3.9 mmHg). PI became identical to PCWP only at fixed high PCWP in group 1 (19 +/- 2.0 vs. 19 +/- 1.1 mmHg). Thus PCWP reflects the effective vascular outflow pressure when PCWP is fixed and high. For both groups of dogs in condition 3, when PCWP was varied with CO, the slope of the resulting PAP-CO plot was significantly greater than when PCWP was constant. Also in 9 of 10 dogs, PI was less than PCWP when PCWP was varied. These findings demonstrate that when changes in PCWP are allowed to occur during the generation of a pulmonary artery pressure-flow plot, the resulting slope and intercept, as defined by a Starling resistor model, do not accurately represent the incremental resistance and outflow pressure of the pulmonary vasculature.

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