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Influence of lung injury on pulmonary wedge-left atrial pressure correlation during positive end-expiratory pressure ventilation.
Am Rev Respir Dis. 1985 Feb; 131(2):246-50.AR

Abstract

The correlation between pulmonary artery wedge pressure (Pw) and left atrial pressure (Pla) requires a continuous fluid column between the catheter tip and the left atrium. We hypothesized that lung injury may protect the fluid column from the collapsing effects of increased airway pressure. Correlation between Pw and Pla would then depend on catheter tip location in injured versus normal lung regions. In 7 anesthetized dogs with unilateral acid pneumonitis, we compared Pla and simultaneous Pw measurements from pulmonary artery catheters located in injured and normal lungs at different levels of positive end-expiratory pressure (PEEP). Studies were repeated in 10 dogs with normal lungs and 5 dogs with bilateral acid pneumonitis. In supine dogs with unilateral lung injury, Pw from the injured lung more accurately reflected Pla than did Pw obtained from the normal lung at PEEP levels of 7 mmHg or higher, in contrast to data from dogs with normal lungs or equally injured lungs. Discrepancies between Pw and Pla at PEEP levels of 7 and 11 mmHg from the normal lung were corrected when that lung was placed in the dependent position to increase venous pressure at the catheter tip. A good Pw-Pla correlation was not guaranteed by catheter tip location below the level of the left atrium during PEEP ventilation. We conclude that the continuity of the fluid column was protected by lung injury. Although Pw-Pla differences from the normal lung were modest at the levels of PEEP that are usually optimal for gas exchange in uneven lung injury, it is recommended that the injured lung should not be avoided during insertion of the balloon-tipped catheter.

Authors

No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

3882033

Citation

Hasan, F M., et al. "Influence of Lung Injury On Pulmonary Wedge-left Atrial Pressure Correlation During Positive End-expiratory Pressure Ventilation." The American Review of Respiratory Disease, vol. 131, no. 2, 1985, pp. 246-50.
Hasan FM, Weiss WB, Braman SS, et al. Influence of lung injury on pulmonary wedge-left atrial pressure correlation during positive end-expiratory pressure ventilation. Am Rev Respir Dis. 1985;131(2):246-50.
Hasan, F. M., Weiss, W. B., Braman, S. S., & Hoppin, F. G. (1985). Influence of lung injury on pulmonary wedge-left atrial pressure correlation during positive end-expiratory pressure ventilation. The American Review of Respiratory Disease, 131(2), 246-50.
Hasan FM, et al. Influence of Lung Injury On Pulmonary Wedge-left Atrial Pressure Correlation During Positive End-expiratory Pressure Ventilation. Am Rev Respir Dis. 1985;131(2):246-50. PubMed PMID: 3882033.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Influence of lung injury on pulmonary wedge-left atrial pressure correlation during positive end-expiratory pressure ventilation. AU - Hasan,F M, AU - Weiss,W B, AU - Braman,S S, AU - Hoppin,F G,Jr PY - 1985/2/1/pubmed PY - 2001/3/28/medline PY - 1985/2/1/entrez SP - 246 EP - 50 JF - The American review of respiratory disease JO - Am Rev Respir Dis VL - 131 IS - 2 N2 - The correlation between pulmonary artery wedge pressure (Pw) and left atrial pressure (Pla) requires a continuous fluid column between the catheter tip and the left atrium. We hypothesized that lung injury may protect the fluid column from the collapsing effects of increased airway pressure. Correlation between Pw and Pla would then depend on catheter tip location in injured versus normal lung regions. In 7 anesthetized dogs with unilateral acid pneumonitis, we compared Pla and simultaneous Pw measurements from pulmonary artery catheters located in injured and normal lungs at different levels of positive end-expiratory pressure (PEEP). Studies were repeated in 10 dogs with normal lungs and 5 dogs with bilateral acid pneumonitis. In supine dogs with unilateral lung injury, Pw from the injured lung more accurately reflected Pla than did Pw obtained from the normal lung at PEEP levels of 7 mmHg or higher, in contrast to data from dogs with normal lungs or equally injured lungs. Discrepancies between Pw and Pla at PEEP levels of 7 and 11 mmHg from the normal lung were corrected when that lung was placed in the dependent position to increase venous pressure at the catheter tip. A good Pw-Pla correlation was not guaranteed by catheter tip location below the level of the left atrium during PEEP ventilation. We conclude that the continuity of the fluid column was protected by lung injury. Although Pw-Pla differences from the normal lung were modest at the levels of PEEP that are usually optimal for gas exchange in uneven lung injury, it is recommended that the injured lung should not be avoided during insertion of the balloon-tipped catheter. SN - 0003-0805 UR - https://www.unboundmedicine.com/medline/citation/3882033/Influence_of_lung_injury_on_pulmonary_wedge_left_atrial_pressure_correlation_during_positive_end_expiratory_pressure_ventilation_ L2 - https://www.atsjournals.org/doi/10.1164/arrd.1985.131.2.246?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -