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Estimating left ventricular filling pressure in patients receiving positive end-expiratory pressure.

Pinsky, Michael R and Vincent, Jean-Louis and De Smet, JM (1991) Estimating left ventricular filling pressure in patients receiving positive end-expiratory pressure. The American Review of Respiratory Disease, 143 (1). 25 - 31. ISSN 0003-0805

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Abstract

In the critically ill, accurate measurements of left ventricular (LV) filling pressure using pulmonary artery occlusion pressure (Ppao) are important for diagnostic and therapeutic purposes. In patients receiving positive end-expiratory pressure (PEEP), Ppao may not reflect LV filling pressure because of elevated pericardial pressure (Ppc). It has been proposed that in humans, Ppc and right atrial pressure (Pra) are equal, so that referencing Ppao to Pra may improve the assessment of LV filling pressure when Ppc is elevated. Similarly, it has also been shown in the dog that nadir Ppao immediately after airway disconnection from PEEP (nadir Ppao), accurately reflects LV filling pressure when LV filling pressure is ⩽ 10 mm Hg. We examined methods of estimating LV filling pressure using Ppao measurements under conditions in which increases in Ppc were the primary determinants of differences in the two measurements. Using left atrial pressure (Pla) relative to Ppc, called transmural Pla (Platm), as LV filling pressure, we compared the accuracy of Ppao, nadir Ppao, and Ppao relative to Pra to reflect Platm in 15 postoperative cardiac surgery patients in whom an air-filled pericardial balloon catheter and a left atrial catheter were inserted during surgery. PEEP was sequentially increased from zero to 15 cm H2O. We found that Pra always exceeded Ppc (p


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Details

Item Type: Article
Status: Published
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Pinsky, Michael Rpinsky@pitt.eduPINSKY
Vincent, Jean-Louis
De Smet, JM
Date: January 1991
Date Type: Publication
Journal or Publication Title: The American Review of Respiratory Disease
Volume: 143
Number: 1
Publisher: American Thoracic Society
Page Range: 25 - 31
DOI or Unique Handle: 10.1164/ajrccm/143.1.25
Schools and Programs: School of Medicine > Critical Care Medicine
Refereed: Yes
ISSN: 0003-0805
Official URL: http://dx.doi.org/10.1164/ajrccm/143.1.25
Article Type: Correspondence/Letter
Additional Information: Am Rev Respir Dis. 1991 Oct;144(4):993-994. Estimating left ventricular filling pressure in patients receiving positive end-expiratory pressure /by Butler J, Albert RK. PMID:1928977
Date Deposited: 05 Jul 2012 14:24
Last Modified: 01 Nov 2017 14:05
URI: http://d-scholarship.pitt.edu/id/eprint/12653

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