Evaluation of the Monitor Cursor-Line Method for Measuring Pulmonary Artery and Central Venous Pressures

2010 ◽  
Vol 19 (6) ◽  
pp. 511-521 ◽  
Author(s):  
Editha Pasion ◽  
Levell Good ◽  
Jisebelle Tizon ◽  
Staci Krieger ◽  
Catherine O’Kier ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Cardiac Surgery ◽  
Pulmonary Artery ◽  
Spontaneous Breathing ◽  
Digital Display ◽  
Central Venous ◽  
Convenience Sample ◽  
Graphic Recording ◽  
Significance Level ◽  
Line Method

Objective To determine if the monitor cursor-line feature on bedside monitors is accurate for measuring central venous and pulmonary artery pressures in cardiac surgery patients. Methods Central venous and pulmonary artery pressures were measured via 3 methods (end-expiratory graphic recording, monitor cursor-line display, and monitor digital display) in a convenience sample of postoperative cardiac surgery patients. Pressures were measured twice during both mechanical ventilation and spontaneous breathing. Analysis of variance was used to determine differences between measurement methods and the percentage of monitor pressures that differed by 4 mm Hg or more from the measurement obtained from the graphic recording. Significance level was set at P less than .05. Results Twenty-five patients were studied during mechanical ventilation (50 measurements) and 21 patients during spontaneous breathing (42 measurements). Measurements obtained via the 3 methods did not differ significantly for either type of pressure (P > .05). Graphically recorded pressures and measurements obtained via the monitor cursor-line or digital display methods differed by 4 mm Hg or more in 4% and 6% of measurements, respectively, during mechanical ventilation and 4% and 11%, respectively, during spontaneous breathing. Conclusion The monitor cursor-line method for measuring central venous and pulmonary artery pressures may be a reasonable alternative to the end-expiratory graphic recording method in hemodynamically stable, postoperative cardiac surgery patients. Use of the digital display on the bedside monitor may result in larger discrepancies from the graphically recorded pressures than when the cursor-line method is used, particularly in spontaneously breathing patients.

Comparison of methods of measuring pulmonary artery pressure

1997 ◽  
Vol 6 (4) ◽  
pp. 324-332 ◽  
Author(s):  
JL Lundstedt
Keyword(s):  
Mechanical Ventilation ◽  
Cardiac Surgery ◽  
Pulmonary Artery ◽  
Pulmonary Artery Pressure ◽  
Spontaneous Breathing ◽  
Systolic Pressure ◽  
Graphic Method ◽  
Difference Scores ◽  
Artery Pressure ◽  
The Difference

BACKGROUND: Pulmonary artery waveforms fluctuate because of changes in intrathoracic pressure caused by respirations. Monitoring system algorithms determine digital displays of pressure measurements on the basis of recognition, analysis, and comparison of consecutive waveforms. OBJECTIVE: To compare three methods of measuring pulmonary artery pressure during mechanical ventilation and spontaneous breathing in cardiac surgery patients with stable hemodynamics. METHODS: Pulmonary artery pressure was measured during mechanical ventilation after cardiac surgery in 53 patients; 37 of the patients were studied again after extubation. Three monitoring methods were compared: graphic strip recording, the "stop cursor" (monitor screen freezing) method, and digital-display recording. Difference scores were calculated between the methods and analyzed for frequency and direction. RESULTS: All comparisons showed differences of at least +/-3 mm Hg in measurements obtained with the three methods. During mechanical ventilation, the digital and graphic measurements of systolic pressure varied most often; 57% (30/53) of the comparisons had difference scores of at least +/-3 mm Hg. The cursor and graphic measurements of diastolic pressures varied least often; 6% (3/53) of the comparisons had difference scores of at least +/-3 mm Hg. As expected, the digital method most often gave higher results than the graphic method. During spontaneous breathing, measurements of systolic pressure varied more often (38% to 53%) than did measurements of diastolic pressure (12% to 37%). Unexpectedly, for systolic pressures, the difference between digital and graphic measurements was 3 mm Hg or more 30% (11/37) of the time, and the difference between cursor and graphic measurements was 3 mm Hg or more 53% (17/32) of the time. CONCLUSIONS: Because of physiological and technical influences, measurements of systolic and diastolic pressures in the pulmonary artery made with the digital and cursor methods were not as reliable as measurements made with the graphic method. The findings support continued use of the graphic method for accurate measurements of pulmonary artery pressure.

scholarly journals Estimation of change in pleural pressure in assisted and unassisted spontaneous breathing pediatric patients using fluctuation of central venous pressure: A preliminary study

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0247360
Author(s):  
Nao Okuda ◽  
Miyako Kyogoku ◽  
Yu Inata ◽  
Kanako Isaka ◽  
Kazue Moon ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Spontaneous Breathing ◽  
Pediatric Patients ◽  
Venous Pressure ◽  
Balloon Catheter ◽  
Pleural Pressure ◽  
Respiratory Effort ◽  
Central Venous ◽  
Mechanically Ventilated ◽  
Esophageal Balloon

Background It is important to evaluate the size of respiratory effort to prevent patient self-inflicted lung injury and ventilator-induced diaphragmatic dysfunction. Esophageal pressure (Pes) measurement is the gold standard for estimating respiratory effort, but it is complicated by technical issues. We previously reported that a change in pleural pressure (ΔPpl) could be estimated without measuring Pes using change in CVP (ΔCVP) that has been adjusted with a simple correction among mechanically ventilated, paralyzed pediatric patients. This study aimed to determine whether our method can be used to estimate ΔPpl in assisted and unassisted spontaneous breathing patients during mechanical ventilation. Methods The study included hemodynamically stable children (aged <18 years) who were mechanically ventilated, had spontaneous breathing, and had a central venous catheter and esophageal balloon catheter in place. We measured the change in Pes (ΔPes), ΔCVP, and ΔPpl that was calculated using a corrected ΔCVP (cΔCVP-derived ΔPpl) under three pressure support levels (10, 5, and 0 cmH2O). The cΔCVP-derived ΔPpl value was calculated as follows: cΔCVP-derived ΔPpl = k × ΔCVP, where k was the ratio of the change in airway pressure (ΔPaw) to the ΔCVP during airway occlusion test. Results Of the 14 patients enrolled in the study, 6 were excluded because correct positioning of the esophageal balloon could not be confirmed, leaving eight patients for analysis (mean age, 4.8 months). Three variables that reflected ΔPpl (ΔPes, ΔCVP, and cΔCVP-derived ΔPpl) were measured and yielded the following results: -6.7 ± 4.8, − -2.6 ± 1.4, and − -7.3 ± 4.5 cmH2O, respectively. The repeated measures correlation between cΔCVP-derived ΔPpl and ΔPes showed that cΔCVP-derived ΔPpl had good correlation with ΔPes (r = 0.84, p< 0.0001). Conclusions ΔPpl can be estimated reasonably accurately by ΔCVP using our method in assisted and unassisted spontaneous breathing children during mechanical ventilation.

Pulmonary artery pressure measurement in patients with elevated pressures: effect of backrest elevation and method of measurement

1992 ◽  
Vol 1 (2) ◽  
pp. 61-69 ◽  
Author(s):  
K Dobbin ◽  
S Wallace ◽  
J Ahlberg ◽  
M Chulay
Keyword(s):  
Mechanical Ventilation ◽  
Mean Arterial Pressure ◽  
Pulmonary Artery ◽  
Pulmonary Artery Pressure ◽  
Mixed Venous Oxygen Saturation ◽  
Graphic Recording ◽  
Artery Pressure ◽  
Normal Breathing ◽  
Venous Oxygen Saturation ◽  
Mixed Venous

OBJECTIVE: To determine whether pulmonary artery pressure measurement is accurate if the head of the bed is elevated; to compare the end-expiratory graphic recording and digital monitor methods for pulmonary artery pressure measurement; to determine whether either mean arterial pressure or mixed venous oxygen saturation changes during backrest elevation. DESIGN: Nonrandomized clinical trial. SETTING: A six-bed cardiac surgical intensive care unit of a 540-bed federal facility. POPULATION: Twenty-five postoperative cardiac surgical patients with elevated pulmonary artery pressures (systolic higher than 35 mm Hg). INTERVENTIONS: In supine patients pulmonary artery pressures were measured at each of the following backrest elevations: 0, 20, 30, 45 and again at 0 degrees. Measurements were obtained once during mechanical ventilation and once during normal breathing after extubation. MAIN OUTCOME MEASURES: End-expiratory graphic recording of pulmonary artery pressures; digital monitor values of pulmonary artery pressures; mean arterial pressure; and mixed venous oxygen saturation. RESULTS: No statistical difference was found in pulmonary artery pressures measured at each of the backrest elevations during mechanical ventilation or normal breathing after extubation. Pulmonary artery diastolic and pulmonary capillary wedge pressures obtained with the digital monitor method were significantly lower than the end expiratory graphic recording method during normal breathing after extubation but not during mechanical ventilation. No changes in mean arterial pressure or mixed venous oxygen saturation occurred during backrest elevation. CONCLUSIONS: These results show that pulmonary artery pressures can be measured accurately with the head of the bed in an elevated position. The data indicate that obtaining pulmonary artery pressure measurements from the digital display of the bedside monitor is accurate when respiratory wave form fluctuations are minimal but may lead to inaccurate values with prominent respiratory fluctuations. Further research is needed to validate this finding in different patient populations and with other models of monitoring equipment.

Comparison of three methods of measurement of pulmonary artery catheter readings in critically ill patients

1995 ◽  
Vol 4 (4) ◽  
pp. 300-307 ◽  
Author(s):  
MK Johnson ◽  
L Schumann
Keyword(s):  
Mechanical Ventilation ◽  
Pulmonary Artery ◽  
Pulmonary Artery Catheter ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Spontaneous Breathing ◽  
Repeated Measures ◽  
Right Atrial ◽  
Significant Difference ◽  
Methods Of Measurement

BACKGROUND: Pulmonary artery catheter readings are critical for clinical decision making and therapeutic intervention in critically ill patients. Research data of digital display versus graphic strip chart recording of hemodynamic pressures during spontaneous breathing and mechanical ventilation are inconclusive. OBJECTIVES: To compare three methods of measurement of hemodynamic pressure readings from the pulmonary artery catheter in critically ill patients during mechanical ventilation and spontaneous breathing. METHODS: A nonrandomized, repeated-measures design was used to compare hemodynamic pressures (right atrial, systolic, diastolic, and wedge pressures) from the pulmonary artery catheter in cardiovascular patients during mechanical ventilation (n = 25) and again during spontaneous breathing (n = 19). RESULTS: Using repeated measures analysis of variance, statistically significant differences were noted in the pulmonary artery diastolic, wedge, and right atrial pressure during mechanical ventilation. During spontaneous breathing, significant differences occurred in pulmonary artery systolic and wedge pressures only. No statistically significant difference occurred in the systolic pressure during mechanical ventilation, or the pulmonary artery diastolic and right atrial pressures during spontaneous breathing. CONCLUSIONS: The results of this study indicate that graphic recording is the most reliable means of measuring hemodynamic pressure at end-expiration. Further research is needed to validate these findings with other models of monitoring equipment and other patient populations.

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