Measurement of trans-alveolar pressure with a pulmonary artery catheter
Authors:
Zvoníček Václav; Suk Pavel; Šrámek Vladimír; Pavlík Martin
Authors‘ workplace:
Anesteziologicko-resuscitační klinika, Fakultní nemocnice u sv. Anny v Brně, Lékařská fakulta Masarykovy univerzity
Published in:
Anest. intenziv. Med., 20, 2009, č. 4, s. 192-199
Category:
Intensive Care Medicine - Original Paper
Overview
Objective:
Trans-alveolar pressure (Pt) is the difference between alveolar pressure and pleural pressure. To calculate Pt it is necessary to measure pleural pressure using an oesophageal balloon which is not commonly available. The aim of the study was to estimate respiratory pleural pressure changes and thereby the trans-alveolar pressure changes using the respiratory swing of central venous pressure, pulmonary artery pressure and pulmonary artery occlusion pressure. The method is based on transmission of pleural pressure changes during the respiratory cycle to the vascular pressures. The hypothesis was that pleural pressure changes during the respiratory cycle were near-equal to the vascular pressure changes.
Setting:
ICU, University Hospital.
Design:
A prospective comparison of two methods of measurement.
Material and methods:
In 23 mechanically ventilated patients we applied different tidal volumes and simultaneously measured the changes of oesophageal pressure (PtES) and vascular pressures using a pulmonary artery catheter. We calculated the changes of trans-alveolar pressure during the respiratory cycle using a standard method – oesophageal pressure – and compared them to the changes of trans-alveolar pressure calculated from CVP (PtCVP), PAP (PtPAP) and PAOP (PtPAOP).
Results:
The bias and limits of agreement according to Bland-Altman were: PtCVP -1.3 (-4.1–1.5), PtPAP 1.6 (-2.3–5.4) and PtPAOP 0.9 (-3.6–5.5) cmH2O. The best results were achieved when estimation of PtES was performed using a pulmonary artery catheter with the tip of the catheter correctly positioned in West Zone III. Eighty percent of the measurements had good clinical agreement under this condition.
Conclusion:
The respiratory swing of trans-alveolar pressure can be acceptably estimated using the pulmonary artery occlusion pressure trace provided that the pulmonary artery catheter is optimally positioned.
Keywords:
pleural pressure – central venous pressure – pulmonary artery wedge pressure – mechanical ventilation
Sources
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Anaesthesiology, Resuscitation and Inten Intensive Care MedicineArticle was published in
Anaesthesiology and Intensive Care Medicine
2009 Issue 4
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