Misinterpretation of pressure measurements from the pulmonary artery catheter

Nadeau, Sylvain; Noble, William H.

doi:10.1007/bf03010750

Cited by 32 publications

(11 citation statements)

References 33 publications

(6 reference statements)

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“…Damped tracings and catheter ‘fling’ may not be recognized, leading to erroneous measurements [38]. These errors are compounded in patients on mechanical ventilators where the use of positive pressure ventilation, spontaneous breaths and the use of positive end expiratory pressure (PEEP) make analysis of the PCWP challenging and unreliable [36][40][41]. …”

Section: Reviewmentioning

confidence: 99%

Obituary: pulmonary artery catheter 1970 to 2013

Marik

2013

Ann Intensive Care

149

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The birth of the intermittent injectate-based conventional pulmonary artery catheter (fondly nicknamed PAC) was proudly announced in the New England Journal of Medicine in 1970 by his parents HJ Swan and William Ganz. PAC grew rapidly, reaching manhood in 1986 where, in the US, he was shown to influence the management of over 40% of all ICU patients. His reputation, however, was tarnished in 1996 when Connors and colleagues suggested that he harmed patients. This was followed by randomized controlled trials demonstrating he was of little use. Furthermore, reports surfaced suggesting that he was unreliable and inaccurate. It also became clear that he was poorly understood and misinterpreted. Pretty soon after that, a posse of rivals (bedside echocardiography, pulse contour technology) moved into the neighborhood and claimed they could assess cardiac output more easily, less invasively and no less reliably. To make matter worse, dynamic assessment of fluid responsiveness (pulse pressure variation, stroke volume variation and leg raising) made a mockery of his ‘wedge’ pressure. While a handful of die-hard followers continued to promote his mission, the last few years of his existence were spent as a castaway until his death in 2013. His cousin (the continuous cardiac output PAC) continues to eke a living mostly in cardiac surgery patients who need central access anyway. This paper reviews the rise and fall of the conventional PAC.

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Section: Reviewmentioning

confidence: 99%

Obituary: pulmonary artery catheter 1970 to 2013

Marik

2013

Ann Intensive Care

149

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“…The median (range) mean arterial blood pressure, central venous pressure, mean pulmonary artery pressure and heart rate were 75 mmHg (49-100), 11 mmHg (4-18), 20 mmHg (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27), and 78 beats min À1 (51-110), respectively. The median (range) mean arterial blood pressure, central venous pressure, mean pulmonary artery pressure and heart rate were 75 mmHg (49-100), 11 mmHg (4-18), 20 mmHg (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27), and 78 beats min À1 (51-110), respectively.…”

Section: Patient Characteristicsmentioning

confidence: 99%

Thermodilution cardiac output – are three injections enough?

Nilsson

Nilssøn

Skovgaard

et al. 2004

Acta Anaesthesiol Scand

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“…It is essential to display the pulmonary artery waveform to avoid overwedging and allow respiratory variations to be observed. End-expiratory readings should be obtained [21], although automatic display of this requires an extremely efficient algorithm, and few systems are able to estimate end-expiratory PAOP during spontaneous ventilation and intermittent positive pressure ventilation (IPPV) with a reversed inspiratory: expiratory ratio.…”

Section: Cardiac Rifling Pressuresmentioning

confidence: 99%

“…A number of confounding factors will negate the use of the PAOP to reflect left atrial pressure (LAP), left ventricular end-diastolic pressure (LVEDP), and LVEDV [21,22].…”

Section: Cardiac Rifling Pressuresmentioning

confidence: 99%

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Practical points in the application of oxygen transport principles

Nightingale

1990

Intensive Care Med

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Application of the principles of oxygen transport in the management of critically ill patients can influence the frequency of organ failure and outcome. Adequate tissue oxygen consumption in these patients may depend on a supranormal level of oxygen delivery. The equations used for calculating oxygen delivery and consumption are provided, and it is noted that clinicians should have a clear understanding of the limitations of each of the measurements included in the equations. The methods used to perform the measurements are reviewed. Widespread acceptance and use of oxygen transport protocols in treatment is only possible if the measurements on which they are based are accurate and properly interpreted.

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Misinterpretation of pressure measurements from the pulmonary artery catheter

Cited by 32 publications

References 33 publications

Obituary: pulmonary artery catheter 1970 to 2013

Obituary: pulmonary artery catheter 1970 to 2013

Thermodilution cardiac output – are three injections enough?

Practical points in the application of oxygen transport principles

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