Pulmonary artery occlusion pressure is not accurate immediately after cardiopulmonary bypass
| Autor: | Jeffrey J. Entress, Gordon N. Olinger, Timothy J. Olund, Margaret B. Hopwood, M. Saeed Dhamee, A. Aggarwal |
|---|---|
| Rok vydání: | 1990 |
| Předmět: |
Male
medicine.medical_specialty medicine.medical_treatment Hemodynamics Pulmonary Artery Ventricular Function Left pCO2 law.invention Intraoperative Period law medicine.artery Internal medicine Myocardial Revascularization Cardiopulmonary bypass Humans Medicine Postoperative Period Prospective Studies Pulmonary wedge pressure Aged Aged 80 and over Cardiopulmonary Bypass business.industry Pulmonary artery catheter Middle Aged Preload Anesthesiology and Pain Medicine medicine.anatomical_structure Anesthesia Pulmonary artery Vascular resistance Cardiology Atrial Function Left Female Cardiology and Cardiovascular Medicine business |
| Zdroj: | Journal of Cardiothoracic Anesthesia. 4:558-563 |
| ISSN: | 0888-6296 |
| DOI: | 10.1016/0888-6296(90)90404-4 |
| Popis: | Elevated pulmonary vascular resistance (PVR), differential cardiac dynamics, and increased lung water following cardiopulmonary bypass (CPB) have been proposed as limitations to the accuracy of the pulmonary artery occlusion pressure (PAOP) in estimating left ventricular preload. A prospective study of 22 patients undergoing elective myocardial revascularization is described wherein PAOP was compared with directly measured left atrial pressure (LAP). The reliability of PAOP to estimate LAP in the hour immediately following CPB and at 1, 4, 8, and 12 hoyrs post-CPB was examined with repeated measures analysis of variance. Relationships between the PAOP-LAP difference and PVR, core temperature, arterial CO2 tension, and right and left ventricular stroke work indices (RVSWI, LVSWI) were tested by linear regression analysis. There was greater variability in measurements at 15, 30, and 45 minutes immediately after CPB, demonstrated by a pooled correlation coefficient of 0.73 versus 0.90 in the postoperative period. The degree of discrepancy between PAOP and LAP lessened with time. There was no determinable relationship of the PAOP-LAP gradient to PVR, level of PCO2, temperature, RVSWI, or LVSWI. Potential sources of discrepancy include airway pressure effects, position of the measuring catheters, positive end-expiratory pressure, infusion of protamine sulfate, extremes of pulmonary artery pressures, and effects of an open pericardium. This study was designed to limit the contribution from these sources, but a consistent pattern of discrepancy was observed. A previously proposed cause of increased lung water following CPB was not supported by the present study. In conclusion, the use of a pulmonary artery catheter alone to estimate left heart filling pressure immediately following CPB may lead to inaccurate ventricular function curves and treatment; however, postoperative use offers acceptable reliability. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|