Interobserver Variability in the Interpretation of Pulmonary Artery Catheter Pressure Tracings

Komadina, Kevin H.; Schenk, Daniela; LaVeau, Paul J.; Duncan, Charles A.; Chambers, Sharde

doi:10.1378/chest.100.6.1647

Cited by 67 publications

(28 citation statements)

References 16 publications

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“…The interobserver variability in interpreting a pulmonary capillary pressure waveform is extremely large, with variations of as much as 23 mm Hg. 10 In addition, it has been shown that physicians consistently fail to make the determination of pulmonary wedge pressure only at end-expiration. 11 The potential for clinical worsening and pulmonary edema caused by the PAH therapies is so great that, in our opinion, a direct measurement of the left ventricular end-diastolic pressure should be performed in any patient in whom an adequate pulmonary capillary wedge pressure cannot be obtained or in whom its validity is in doubt.…”

Section: Uncertainties In the Clinical Diagnosis Of Pulmonary Hypertementioning

confidence: 99%

Uncertainties in the Diagnosis and Treatment of Pulmonary Arterial Hypertension

2008

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Abstract-The availability of new treatments for patients with pulmonary arterial hypertension has increased awareness and interest in the medical community for pulmonary vascular diseases in general. Many uncertainties exist, however, regarding the diagnosis and treatment of patients with pulmonary arterial hypertension that are particularly pertinent for the management of patients with idiopathic pulmonary arterial hypertension and pulmonary hypertension associated with underlying diseases. This review highlights controversial issues around the definition and diagnosis of pulmonary hypertension, the interpretation of hemodynamic variables, and the interpretation of clinical responsiveness to chronic therapies. In addition, we propose guidelines applicable to the conduct of new therapeutic trials in pulmonary arterial hypertension, which aim to provide greater confidence in the efficacy and safety of new treatments currently under development. Key Words: catheterization Ⅲ hypertension, pulmonary Ⅲ hypoxia Ⅲ trials Ⅲ vasoconstriction P ulmonary hypertension from any cause is more prevalent than previously believed. As reported in a Centers for Disease Control study of the prevalence of pulmonary hypertension in the United States, more than 260 000 people were discharged from the hospital with a diagnosis of pulmonary hypertension in 2002. 1 It is likely that the increasing attention being paid to making a diagnosis of pulmonary hypertension is related to the fact that there are now therapies available that were not available a decade ago to treat these patients. 2 Furthermore, the broad availability of Doppler echocardiography has helped with (earlier) detection of pulmonary hypertension.A new classification of clinical pulmonary hypertension, which was revised recently, 3 designated 5 categories that are distinctive because they differ in their clinical presentation, diagnostic findings, and response to treatment (Table 1). 4 As we now know, a treatment that is effective for one cause of pulmonary hypertension can worsen the prognosis for pulmonary hypertension due to a different cause. 5 Equally important is the fact that some treatments for pulmonary hypertension can be lifesaving, and the failure to make a correct diagnosis in a patient who is potentially curable could be catastrophic. 6 It is also important to emphasize that the approved treatments for pulmonary arterial hypertension (PAH; category 1, the only category of pulmonary hypertension for which treatments are approved) have serious side effects, are exceedingly expensive, and have not been shown to be effective in patients with other forms of pulmonary hypertension. When one takes into account the mortality associated with pulmonary hypertension, as well as the risks and benefits of the different treatments, it becomes apparent that an accurate diagnosis of the cause of pulmonary hypertension is as essential as the correct diagnosis of the type of tumor in a patient with cancer. Uncertainties With the Definition of PAHThere appear to be discrepanci...

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Section: Uncertainties In the Clinical Diagnosis Of Pulmonary Hypertementioning

confidence: 99%

Uncertainties in the Diagnosis and Treatment of Pulmonary Arterial Hypertension

2008

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“…Limitations to the pulmonary artery catheterization include the interobserver interpretation variability in the analysis of the tracings 128 with consequent treatment inadequacy, as well as the occurrence of potentially fatal complications. with the objective of maintaining percutaneous saturation above 90%.…”

Section: Monitoringmentioning

confidence: 99%

“…The use of PAC was related to the high frequency of complications and high costs 128 , and its interpretation has high variability among physicians 149 .…”

Section: Invasive Hemodynamic Monitoringmentioning

confidence: 99%

I Diretriz Latino-Americana para avaliação e conduta na insuficiência cardíaca descompensada

Bocchi¹,

Vilas-Boas²,

Perrone³

et al. 2005

Arq. Bras. Cardiol.

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“…Although the dependence of reviewers on information from medical records means some loss of data as compared with bedside assessment, this is more than compensated by the fact that all testing and clinical data (including the course of disease) become shown multiple times, its accuracy in routine clinical practice is limited. [19][20][21] The Fluids and Catheters Treatment Trial (FACTT) showed that about onethird of the patients with ALI in the pulmonary artery catheter portion of the trial had a PAOP . 18 mm Hg at the time of catheter insertion.…”

Section: Discussionmentioning

confidence: 99%

Decision Support Tool for Early Differential Diagnosis of Acute Lung Injury and Cardiogenic Pulmonary Edema in Medical Critically Ill Patients

Schmickl

Shahjehan

et al. 2012

Chest

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T he fi nding of acute hypoxemia and bilateral lung infi ltrates on frontal chest radiograph is common in the ICU setting, and differentiation between cardiogenic pulmonary edema (CPE) and noncardiogenic pulmonary edema (acute lung injury [ALI]) is diffi cult and challenging in the early stages of illness. 1,2 Left atrial hypertension (LAH) as a principal cause of acute pulmonary edema must be excluded before making a diagnosis of ALI and its more severe form, ARDS. 3 Conversely, to exclude ALI, one needs not only the evidence of LAH but also the absence of signifi cant ALI risk factors. Traditionally, a pulmonary artery occlusion pressure (PAOP) . 18 mm Hg has been used as a surrogate marker of LAH. It is rarely used in current clinical practice because it is invasive, the effi cacy of pulmonary artery catheter-guided therapy in critically ill patients has not been proven, 4 and some studies have suggested increased morbidity and mortality associated with its use. Abbreviations: AECC 5 American European Consensus Conference; ALI 5 acute lung injury; AUC 5 area under curve; BNP 5 brain natriuretic peptide; CAD 5 coronary artery disease; CPE 5 cardiogenic pulmonary edema; CVP 5 central venous pressure; DC 5 development cohort; E/E 9 5 ratio of mitral peak velocity of early fi lling (E) to early diastolic mitral annular velocity (E 9 ); HL 5 Hosmer-Lemeshow test; IQR 5 interquartile range; LAH 5 left atrial hypertension; LBBB 5 left bundle branch block; PAOP 5 pulmonary occlusion pressure; Sp o 2 5 peripheral oxygen saturation; VC 5 validation cohort

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Interobserver Variability in the Interpretation of Pulmonary Artery Catheter Pressure Tracings

Cited by 67 publications

References 16 publications

Uncertainties in the Diagnosis and Treatment of Pulmonary Arterial Hypertension

Uncertainties in the Diagnosis and Treatment of Pulmonary Arterial Hypertension

I Diretriz Latino-Americana para avaliação e conduta na insuficiência cardíaca descompensada

Decision Support Tool for Early Differential Diagnosis of Acute Lung Injury and Cardiogenic Pulmonary Edema in Medical Critically Ill Patients

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