Document Detail


Estimating cardiac filling pressure in mechanically ventilated patients with hyperinflation.
MedLine Citation:
PMID:  11098965     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: When positive end-expiratory pressure (PEEP) is applied, the intracavitary left ventricular end-diastolic pressure (LVEDP) exceeds the LV filling pressure because pericardial pressure exceeds 0 at end-expiration. Under those conditions, the LV filling pressure is itself better reflected by the transmural LVEDP (tLVEDP) (LVEDP minus pericardial pressure). By extension, end-expiratory pulmonary artery occlusion pressure (eePAOP), as an estimate of end-expiratory LVEDP, overestimates LV filling pressure when pericardial pressure is >0, because it occurs when PEEP is present. We hypothesized that LV filling pressure could be measured from eePAOP by also knowing the proportional transmission of alveolar pressure to pulmonary vessels calculated as index of transmission = (end-inspiratory PAOP--eePAOP)/(plateau pressure--total PEEP). We calculated transmural pulmonary artery occlusion pressure (tPAOP) with this equation: tPAOP = eePAOP--(index of transmission x total PEEP). We compared tPAOP with airway disconnection nadir PAOP measured during rapid airway disconnection in subjects undergoing PEEP with and without evidence of dynamic pulmonary hyperinflation. DESIGN: Prospective study. SETTING: Medical intensive care unit of a university hospital. PATIENTS: We studied 107 patients mechanically ventilated with PEEP for acute respiratory failure. Patients without dynamic pulmonary hyperinflation (group A; n = 58) were analyzed separately from patients with dynamic pulmonary hyperinflation (group B; n = 49). INTERVENTION: Transient airway disconnection. MEASUREMENTS AND MAIN RESULTS: In group A, tPAOP (8.5+/-6.0 mm Hg) and nadir PAOP (8.6+/-6.0 mm Hg) did not differ from each other but were lower than eePAOP (12.4+/-5.6 mm Hg; p < .05). The agreement between tPAOP and nadir PAOP was good (bias, 0.15 mm Hg; limits of agreement, -1.5-1.8 mm Hg). In group B, tPAOP (9.7+/-5.4 mm Hg) was lower than both nadir PAOP and eePAOP (12.1+/-5.4 and 13.9+/-5.2 mm Hg, respectively; p < .05 for both comparisons). The agreement between tPAOP and nadir PAOP was poor (bias, 2.3 mm Hg; limits of agreement, -0.2-4.8 mm Hg). CONCLUSIONS: Indexing the transmission of proportional alveolar pressure to PAOP in the estimation of LV filling pressure is equivalent to the nadir method in patients without dynamic pulmonary hyperinflation and may be more reliable than the nadir PAOP method in patients with dynamic pulmonary hyperinflation.
Authors:
J L Teboul; M R Pinsky; A Mercat; N Anguel; G Bernardin; J M Achard; T Boulain; C Richard
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Critical care medicine     Volume:  28     ISSN:  0090-3493     ISO Abbreviation:  Crit. Care Med.     Publication Date:  2000 Nov 
Date Detail:
Created Date:  2000-12-11     Completed Date:  2000-12-11     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0355501     Medline TA:  Crit Care Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  3631-6     Citation Subset:  AIM; IM    
Affiliation:
Service de Réanimation Médicale, Hopital de Bicêtre, Assitance Publique, Faculté de Médecine Paris-Sud, Université Paris XI, France.
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MeSH Terms
Descriptor/Qualifier:
Aged
Blood Pressure / physiology*
Diastole / physiology
Female
Humans
Intensive Care*
Lung / physiopathology*
Male
Middle Aged
Positive-Pressure Respiration*
Prospective Studies
Pulmonary Alveoli / physiopathology
Pulmonary Edema / physiopathology,  therapy
Pulmonary Wedge Pressure / physiology
Respiratory Distress Syndrome, Adult / physiopathology,  therapy
Respiratory Insufficiency / physiopathology,  therapy*
Ventricular Function, Left / physiology*
Comments/Corrections
Comment In:
Crit Care Med. 2000 Nov;28(11):3759-60   [PMID:  11098991 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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