Pulmonary Artery Catheterization
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Abstract For years, the pulmonary artery catheter (PAC, better known as Swan-Ganz catheter) has been used largely to estimate and optimize hemodynamics according to the wedge pressure of the pulmonary artery. Its use dramatically declined after reports of complications and increased costs without benefit to patients. In the absence of reliable noninvasive devices, the catheter is used in severe cases and in cardiac surgery intensive care units.Keywords:
Pulmonary wedge pressure
Pulmonary artery catheter
Cardiac catheterization
In the present study, cardiac output in mechanically ventilated patients were determined using three methods including modified CO2-Fick (mCO2F), pulmonary artery catheter (PAC), and pulse induced contour cardiac output (PiCCO) methods and the results were compared to assess the effectiveness of mCO2F method in measuring the cardiac output.Mechanically ventilated and hemodynamically unstable patients (n=39) were sedated and intubated with Swan-Ganz or PiCCO arterial catheters. At the beginning of the experiment and at 4 h after the experiment, the CO2 concentration in expiratory air was measured through a CO2 monitor and it was used further in the cardiac output calculation using mCO2F method. The cardiac output was also determined using PAC and PiCCO methods.The cardiac output determined by PAC and mCO2F method was not significantly (P>0.05) different [5.53±2.85 L.min(-1) (PAC) and 5.96±2.92 L.min(-1) (mCO2F)] at the beginning of the experiment and [6.22±2.7 L.min(-1) (PAC) and 6.36±2.35 L.min(-1) (mCO2F)] at 4 h after the experiment; however, they were highly correlated (r=0.939 and 0.908, P<0.001). The cardiac output determined by PiCCO and mCO2F method was also not significantly (P>0.05) different [6.05±2.49 L.min(-1) (PiCCO) and 5.44±1.64 L.min(-1) (mCO2F)] at the beginning of the experiment, and [6.17±2.04 L.min(-1) (PiCCO) and 5.70±1.72 L.min(-1) (mCO2F)] at 4 h after the experiment; however, they were highly correlated (r=0.776 and 0.832, P<0.001).The mCO2F method could accurately measure the cardiac output in mechanically ventilated patients without using any expensive equipment's and invasive procedures.
Pulmonary artery catheter
Arterial catheter
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Pulmonary artery catheter
Pulmonary wedge pressure
Preload
Cardiac index
Cardiac catheterization
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Abstract Correlations between pulmonary artery and pulmonary vein wedge pressures were investigated in 13 patients with atrial septal defect and 1 patient with Tetralogy of Fallot. Pulmonary vein wedge pressure wave form resembled that of pulmonary artery pressure, and the former lagged behind the latter by 70 to 110 msec (mean 88 ± 14) as observed by the fluid‐filled catheter system. Diastolic pulmonary artery and diastolic pulmonary vein wedge pressures were nearly identical. Although systolic and mean pulmonary artery pressures correlated well with respective pulmonary vein wedge pressures, there were discrepancies when systolic and mean pulmonary artery pressure exceeded 35 and 20 mm Hg, respectively. However, systolic and mean pulmonary artery pressures could be estimated by adding the difference between the diastolic pulmonary vein wedge pressure and the mean left atrial pressure to corresponding systolic or mean pulmonary artery pressure. In conclusion, pulmonary artery pressures can be estimated by measuring pulmonary vein wedge pressures and the mean left atrial pressure.
Pulmonary wedge pressure
Left pulmonary artery
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The Mostcare monitor is a non-invasive cardiac output monitor. It has been well validated in cardiac surgical patients but there is limited evidence on its use in patients with severe sepsis and septic shock.The study included the first 22 consecutive patients with severe sepsis and septic shock in whom the floatation of a pulmonary artery catheter was deemed necessary to guide clinical management. Cardiac output measurements including cardiac output, cardiac index and stroke volume were simultaneously calculated and recorded from a thermodilution pulmonary artery catheter and from the Mostcare monitor respectively. The two methods of measuring cardiac output were compared by Bland-Altman statistics and linear regression analysis. A percentage error of less than 30% was defined as acceptable for this study.Bland-Altman analysis for cardiac output showed a Bias of 0.31 L.min-1, precision (=SD) of 1.97 L.min-1 and a percentage error of 62.54%. For Cardiac Index the bias was 0.21 L.min-1.m-2, precision of 1.10 L.min-1.m-2 and a percentage error of 64%. For stroke volume the bias was 5 mL, precision of 24.46 mL and percentage error of 70.21%. Linear regression produced a correlation coefficient r2 for cardiac output, cardiac index, and stroke volume, of 0.403, 0.306, and 0.3 respectively.Compared to thermodilution cardiac output, cardiac output studies obtained from the Mostcare monitor have an unacceptably high error rate. The Mostcare monitor demonstrated to be an unreliable monitoring device to measure cardiac output in patients with severe sepsis and septic shock on an intensive care unit.
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Objective To assess the accuracy of pulse-indicator continuous cardiac output (PiCCO) for the hemodynamics monitoring. Methods 30 critically ill patients with different etiological factors were admitted into intensive care unit. Hemodynamics of each patient was monitored by pulse-indicator continuous cardiac output and pulmonary artery catheter simultaneously. Correlation between the two methods was compared. Results Linear regression analysis revealed the two methods had good correlation [r=0.865 for cardiac output, r=0.879 for cardiac index, r=0.824 for stroke volume, r=0.833 for systemic vascular resistance]. Conclusion PiCCO can provide effectively hemodynamics monitoring for the management of the critical illness.
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The effects of endotoxin on pulmonary hemodynamics were studied in seven intact dogs. The distribution of pulmonary vascular resistance was estimated by the effective pulmonary capillary pressure, which was derived from the pressure transient recorded while the pulmonary artery catheter was rapidly wedged. After the injection of endotoxin, cardiac output and aortic pressure consistently fell. Pulmonary artery occlusion (wedge) pressure also decreased, but not significantly. Although pulmonary artery pressure did not necessarily rise, total pulmonary vascular resistance increased in every dog. The absolute increase in pulmonary artery resistance was greater (142 mm Hg/L X min/kg); than in venous resistance (111 mm Hg/L X min/kg); however, the relative increase in venous resistance was higher (410% for venous resistance vs. 220% for pulmonary artery resistance). As a result of venoconstriction, there was a consistent increase in effective pulmonary capillary pressure (from 2.5 to 6.3 mm Hg). Our data indicate that the pulmonary vascular response to endotoxin injection is characterized by constriction of both pulmonary arteries and pulmonary veins. The capillary wedge pressure did not reflect the pulmonary microvascular pressure, since it varied in the opposite direction to the effective capillary pressure.
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Constriction
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Abstract For years, the pulmonary artery catheter (PAC, better known as Swan-Ganz catheter) has been used largely to estimate and optimize hemodynamics according to the wedge pressure of the pulmonary artery. Its use dramatically declined after reports of complications and increased costs without benefit to patients. In the absence of reliable noninvasive devices, the catheter is used in severe cases and in cardiac surgery intensive care units.
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Pulmonary artery catheter
Cardiac catheterization
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Pulmonary wedge pressure
Wedge (geometry)
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BACKGROUND: Despite demonstrated benefits of lateral positioning, critically ill patients may require prolonged supine positioning to obtain reproducible hemodynamic measurements. OBJECTIVES: TO determine the effect of 30 degree right and left lateral positions on pulmonary artery and pulmonary artery wedge pressures after cardiac surgery in critically ill adult patients. METHODS: An experimental repeated-measures design was used to study 35 patients with stable hemodynamics after cardiac surgery. Subjects were randomly assigned to 1 of 2 position sequences. Pulmonary artery and pulmonary artery wedge pressures were measured in each position. RESULTS: Measurements obtained from patients in the 30 degree left lateral position differed significantly (all Ps < .05) from measurements obtained from patients in the supine position for pulmonary artery systolic, end-diastolic, and mean pressures. Pulmonary artery wedge pressures did not differ significantly; however, data were available from only 17 subjects. The largest mean difference in pressures between the 2 positions was 2.0 +/- 2.1 mm Hg for pulmonary artery systolic pressures, whereas maximum differences for end-diastolic and pulmonary artery wedge pressures were 1.4 +/- 2.7 mm Hg and 1.6 +/- 2.4 mm Hg, respectively. Clinically significant position-related changes in pressure occurred in 12 (2.1%) of 581 pressure pairs. Clinically significant changes occurred in end-diastolic pressure in 2 subjects and in pulmonary artery wedge pressure in 1 subject. CONCLUSiONS: In patients with stable hemodynamics during the first 12 to 24 hours after cardiac surgery, measurements of pulmonary artery and pulmonary artery wedge pressures obtained in the 30 degree lateral and supine positions are clinically interchangeable.
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