Misled by the Wedge?

Raper, Raymond F.; Sibbald, William J.

doi:10.1378/chest.89.3.427

Cited by 214 publications

(8 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The current study has several limitations. Although particular attention was directed towards the precise measurement of PAOP during RHC, this gold standard suffers from intrinsic substantial well-identified limitations [ 6 ] that could have altered the relationship between Doppler indices and invasive PAOP values. Heart rate and age, which are known to physiologically influence Doppler flow patterns [ 42 ], have not been taken into account in our data analysis.…”

Section: Discussionmentioning

confidence: 99%

“…Currently proposed haemodynamic criterion for the diagnosis of acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) is a pulmonary artery wedge pressure ≤ 18 mmHg [ 4 ], usually measured during RHC. This invasive procedure may lead to relevant complications [ 5 ] and is limited by confounding factors for the measurement of PAOP in ventilated patients [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Echocardiographic assessment of pulmonary artery occlusion pressure in ventilated patients: a transoesophageal study

et al. 2008

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Echocardiographic assessment of pulmonary artery occlusion pressure in ventilated patients: a transoesophageal study

et al. 2008

View full text Add to dashboard Cite

show abstract

“…The PCWP suffers from the same limitation as the central venous pressure (CVP) [56][57]. Multiple studies have shown a poor relationship between the PCWP and circulating blood volume, SV and left ventricular end-diastolic volume [58][59][60][61][62][63]. Furthermore, the PCWP is unable to predict fluid responsiveness [64][65][66].…”

Section: Reviewmentioning

confidence: 99%

Obituary: pulmonary artery catheter 1970 to 2013

Marik

2013

Ann Intensive Care

151

View full text Add to dashboard Cite

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.

show abstract

“…This practice persists despite numerous studies showing that cardiac filling pressures are often misleading when used to predict the effects of volume expansion on cardiac output (CO). [1][2][3][4][5] Even the assessment of left ventricular end-diastolic area (LVEDA) with echocardiography is not necessarily a good predictor of fluid responsiveness. 5,6 Systolic pressure variation (SPV) and pulse pressure variation (PPV) during mechanical ventilation have been shown to predict the hemodynamic effects of volume expansion in patients with septic shock.…”

mentioning

confidence: 99%