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Intensive Care Medicine
Published in: Intensive Care Medicine 11/2007

01-11-2007 | Brief Report

Variations in pulmonary artery occlusion pressure to estimate changes in pleural pressure

Authors: Patrick Bellemare, Peter Goldberg, Sheldon A. Magder

Published in: Intensive Care Medicine | Issue 11/2007

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Abstract

Objective

A readily available assessment of changes in pleural pressure would be useful for ventilator and fluid management in critically ill patients. We examined whether changes in pulmonary artery occlusion pressure (Ppao) adequately reflect respiratory changes in pleural pressure as assessed by changes in intraesophageal balloon pressure (Peso).
We studied patients who had a pulmonary catheter and esophageal balloon surrounding a nasogastric tube as part of their care (n = 24). We compared changes in Ppao (dPpao) to changes in Peso (dPeso) by Bland–Altman and regression analysis. Adequacy of balloon placement was assessed by performing Mueller maneuvers and adjusting the position to achieve a ratio of dPeso to change in tracheal pressure (dPtr) of 0.85 or higher. This was achieved in only 14 of the 24 subjects. We also compared dCVP to dPeso.
The dPpao during spontaneous breaths and positive pressure breaths gave a good estimate of Peso but generally underestimated dPeso (bias = 2.2 +8.2 and –3.9 cmH2O for the whole group). The dCVP was not as good a predictor (bias = 2.9 +10.3 and –4.6).
In patients who have a pulmonary artery catheter in place dPpao gives a lower estimate of changes in pleural pressure and may be more reliable than dPeso. The dCVP is a less reliable predictor than changes in pleural pressure.
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Metadata
Title
Variations in pulmonary artery occlusion pressure to estimate changes in pleural pressure
Authors
Patrick Bellemare
Peter Goldberg
Sheldon A. Magder
Publication date
01-11-2007
Publisher
Springer-Verlag
Published in
Intensive Care Medicine / Issue 11/2007
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-007-0842-5

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