Tags

Type your tag names separated by a space and hit enter

Pulmonary capillary pressures during the acute respiratory distress syndrome.
Intensive Care Med. 2003 Dec; 29(12):2174-2179.IC

Abstract

OBJECTIVES

(1). To describe the evolution of pulmonary capillary pressure (Pcap) and of the pressure drop across the pulmonary venous bed from early to established acute respiratory distress syndrome (ARDS), (2). to assess Pcap under different levels of positive end-expiratory pressure (PEEP) and (3). to compare the visual method and a mathematical model to determine Pcap.

DESIGN

Prospective, intervention study.

SETTING

Intensive care unit in a teaching institution.

PATIENTS

Nine ARDS patients, according to the ARDS Consensus Conference criteria.

INTERVENTIONS

Pulmonary arterial pressures were measured during routine respiratory mechanics measurements throughout ARDS. Four PEEP levels (6, 9, 12 and 15 cmH(2)O) were studied.

MEASUREMENTS AND RESULTS

Pulmonary artery occlusions were made in triplicate at each PEEP level. Pcap was determined for every occlusion trace by three observers (visual method) and a mathematical model. Diastolic pulmonary artery pressure (PAPd) and pulmonary artery occlusion pressure (PAOP) were measured. The visually determined Pcap showed a bias of 2.5+/-2.1 mmHg as compared to the mathematical estimation. PAPd, Pcap and PAOP tended to decrease from early to late ARDS (p=0.128, 0.265, 0.121). Pcap-PAOP (6.3+/-2.7 mmHg) did not change throughout ARDS. Higher PEEP levels were associated with increased PAPd, Pcap and PAOP, as well as with larger Pcap-PAOP throughout ARDS.

CONCLUSIONS

Pulmonary capillary pressure cannot be predicted from PAOP during early and established ARDS. The high variability in Pcap-PAOP increases the risk for underestimation of filtration pressures and consequently the risk for lung edema. Pcap can be estimated at the bedside by either the visual or mathematical methods.

Authors+Show Affiliations

Critical Care Research Program, Division of Intensive Care, Department of Anesthesiology and Intensive Care , Kuopio University Hospital, Kuopio, Finland.Critical Care Research Program, Division of Intensive Care, Department of Anesthesiology and Intensive Care , Kuopio University Hospital, Kuopio, Finland.Department of Intensive Care, Bern University Hospital-Inselspital, 3010 , Bern, Switzerland. Jukka.Takala@insel.ch.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

14586495

Citation

Nunes, Silvia, et al. "Pulmonary Capillary Pressures During the Acute Respiratory Distress Syndrome." Intensive Care Medicine, vol. 29, no. 12, 2003, pp. 2174-2179.
Nunes S, Ruokonen E, Takala J. Pulmonary capillary pressures during the acute respiratory distress syndrome. Intensive Care Med. 2003;29(12):2174-2179.
Nunes, S., Ruokonen, E., & Takala, J. (2003). Pulmonary capillary pressures during the acute respiratory distress syndrome. Intensive Care Medicine, 29(12), 2174-2179. https://doi.org/10.1007/s00134-003-2036-0
Nunes S, Ruokonen E, Takala J. Pulmonary Capillary Pressures During the Acute Respiratory Distress Syndrome. Intensive Care Med. 2003;29(12):2174-2179. PubMed PMID: 14586495.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Pulmonary capillary pressures during the acute respiratory distress syndrome. AU - Nunes,Silvia, AU - Ruokonen,Esko, AU - Takala,Jukka, Y1 - 2003/10/29/ PY - 2002/12/20/received PY - 2003/09/10/accepted PY - 2003/10/31/pubmed PY - 2004/4/14/medline PY - 2003/10/31/entrez SP - 2174 EP - 2179 JF - Intensive care medicine JO - Intensive Care Med VL - 29 IS - 12 N2 - OBJECTIVES: (1). To describe the evolution of pulmonary capillary pressure (Pcap) and of the pressure drop across the pulmonary venous bed from early to established acute respiratory distress syndrome (ARDS), (2). to assess Pcap under different levels of positive end-expiratory pressure (PEEP) and (3). to compare the visual method and a mathematical model to determine Pcap. DESIGN: Prospective, intervention study. SETTING: Intensive care unit in a teaching institution. PATIENTS: Nine ARDS patients, according to the ARDS Consensus Conference criteria. INTERVENTIONS: Pulmonary arterial pressures were measured during routine respiratory mechanics measurements throughout ARDS. Four PEEP levels (6, 9, 12 and 15 cmH(2)O) were studied. MEASUREMENTS AND RESULTS: Pulmonary artery occlusions were made in triplicate at each PEEP level. Pcap was determined for every occlusion trace by three observers (visual method) and a mathematical model. Diastolic pulmonary artery pressure (PAPd) and pulmonary artery occlusion pressure (PAOP) were measured. The visually determined Pcap showed a bias of 2.5+/-2.1 mmHg as compared to the mathematical estimation. PAPd, Pcap and PAOP tended to decrease from early to late ARDS (p=0.128, 0.265, 0.121). Pcap-PAOP (6.3+/-2.7 mmHg) did not change throughout ARDS. Higher PEEP levels were associated with increased PAPd, Pcap and PAOP, as well as with larger Pcap-PAOP throughout ARDS. CONCLUSIONS: Pulmonary capillary pressure cannot be predicted from PAOP during early and established ARDS. The high variability in Pcap-PAOP increases the risk for underestimation of filtration pressures and consequently the risk for lung edema. Pcap can be estimated at the bedside by either the visual or mathematical methods. SN - 0342-4642 UR - https://www.unboundmedicine.com/medline/citation/14586495/Pulmonary_capillary_pressures_during_the_acute_respiratory_distress_syndrome_ L2 - https://dx.doi.org/10.1007/s00134-003-2036-0 DB - PRIME DP - Unbound Medicine ER -