Pulmonary artery occlusive pressure

Pulmonary artery catheter measurements decreased CO, decreased SV, increased SVR, low PAOP (pulmonary artery occlusion pressure)... 

FIGURE 10-4. Treatment algorithm for the management of moderate to severe hypovolemia. BP, blood pressure CVP, central venous pressure ECG, electrocardiogram MAP, mean arterial pressure PA, pulmonary artery PAOP, pulmonary artery occlusion pressure PRBCs, packed red blood cells SBP, systolic blood pressure. 

Upon stabilization, placement of a pulmonary artery (PA) catheter may be indicated based on the need for more extensive cardiovascular monitoring than is available from non-invasive measurements such as vital signs, cardiac rhythm, and urine output.9,10 Key measured parameters that can be obtained from a PA catheter are the pulmonary artery occlusion pressure, which is a measure of preload, and CO. From these values and simultaneous measurement of HR and blood pressure (BP), one can calculate the left ventricular SV and SVR.10 Placement of a PA catheter should be reserved for patients at high risk of death due to the severity of shock or preexisting medical conditions such as heart failure.11 Use of PA catheters in broad populations of critically ill patients is somewhat controversial because clinical trials have not shown consistent benefits with their use.12-14 However, critically ill patients with a high severity of illness may have improved outcomes from PA catheter placement. It is not clear why this was... 

Preload The stretched condition of the heart muscle at the end of diastole just before contraction volume in the left ventricle at the end of diastole estimated by the pulmonary artery occlusion pressure (also known as the pulmonary artery wedge pressure or pulmonary capillary wedge pressure). 

Pulmonary artery catheter An invasive device used to measure hemodynamic parameters directly, including cardiac output and pulmonary artery occlusion pressure calculated parameters include stroke volume and systemic vascular resistance. 

Invasive hemodynamic monitoring should be considered in patients who are refractory to initial therapy, whose volume status is unclear, or who have clinically significant hypotension such as systolic BP <80 mm Hg. Such monitoring helps guide treatment and classify patients into four specific hemodynamic subsets based on cardiac index and pulmonary artery occlusion pressure (PAOP). Refer to textbook Chap. 16 (Heart Failure) for more information. 

A pulmonary artery (Swan-Ganz) catheter can be used to determine central venous pressure (CVP) pulmonary artery pressure CO and pulmonary artery occlusive pressure (PAOP), an approximate measure of the left ventricular end-diastolic volume and a major determinant of left ventricular preload. 

A pulmonary artery (Swan-Ganz) catheter can be used to determine central venous pressure (CVP) pulmouary artery pressure CO aud pulmonary artery occlusive pressure (PAOP), an approximate measure of the left ventricular eud-diastolic volume aud a major determinaut of left veutricular preload. CO (2.5 to 3 L/min) and mixed venous oxygeu saturatiou (70% to 75%) may be very low in a patient with extensive myocardial damage. Respiratory alkalosis is associated with low partial pressure of O2 (25 to 35 mm Hg) and alkaline pH, but uormal bicarbouate. The first two values are measured by arterial blood gas, which also yields partial pressure of carbon dioxide and arterial oxygen saturation. Circulating arterial oxygen saturation can also be measured by an oximeter, which is a noninvasive method that is fairly accurate and useful at the patient s bedside. 

FIGURE 14-3. Relationship between cardiac output (shown as cardiac index, which is CO/BSA) and preload (shown as pulmonary artery occlusion pressure). 

FIGURE 14-9. Hemodynamic subsets of heart failure based on cardiac index and pulmonary artery occlusion pressure. (Adapted with permission from N Engl j Med 1976 295 1356-1362.)... 

PAOP pulmonary artery occlusion pressure P-gp P-glycoprotein RAA renin-angiotensin-aldosterone RVF right ventricular failure SDC serum digoxin concentration S VR systemic vascular resistance TNF-a tumor necrosis factor-a TZD thiazolidinedione VAD ventricular assist device... 

The adverse effects associated with the use of verapamil include constipation, sinus node blockade, prolongation of the PR interval, AV dissociation, hypotension, and pulmonary congestion." The risks may outweigh the benefits in patients with (1) a markedly elevated pulmonary capillary wedge pressure or pulmonary artery occlusion pressure, (2) a history of paroxysmal nocturnal dyspnea or orthopnea, (3) sick sinus syndrome or significant AV nodal disease in the absence of a permanent pacemaker, (4) low systolic blood pressure, and (5) a substantial outflow gradient.Verapamil should be avoided inpatients with heart failure owing to systolic dysfunction. There is no evidence that either /3-blockade or verapamil protects the patient from sudden cardiac death. 

Pc = capillary hydrostatic pressure (indirectly estimated in the clinical setting, e.g., pulmonary artery occlusive pressure)... 

Pulmonary artery occlusion pressure—It is usually determined by a balloon-tipped Swan-Ganz catheter that is advanced into a distal branch of the pulmonary artery. Inflation of the balloon at the catheter tip occludes the pulmonary artery and allows measurement of the left atrial pressure which reflects the left ventricular diastolic pressure. Therefore, it is a measure of the left ventricular preload. 

Xhe triad of pulmonary arterial hypertension, radiographic evidence of pulmonary edema, and normal pulmonary artery occlusion pressure suggests PVOD. Xhe definitive diagnosis of PVOD requires surgical lung biopsy or necropsy. Xhere is no proven therapy for PVOD. Xhere are case reports of steroid therapy in BMX recipients with PVOD, with conflicting results (1). 

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