Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
SHR Neuro Krebs Kardio Lipid Stoffw Microb
Kovacs, G; Avian, A; Pienn, M; Naeije, R; Olschewski, H.
Reading pulmonary vascular pressure tracings. How to handle the problems of zero leveling and respiratory swings.
Am J Respir Crit Care Med. 2014; 190(3):252-257
Doi: 10.1164/rccm.201402-0269PP
Web of Science
PubMed
FullText
FullText_MUG
- Führende Autor*innen der Med Uni Graz
- Kovacs Gabor
- Co-Autor*innen der Med Uni Graz
- Avian Alexander
- Olschewski Horst
- Pienn Michael
- Altmetrics:
- Dimensions Citations:
- Plum Analytics:
- Scite (citation analytics):
- Abstract:
- The accuracy of pulmonary vascular pressure measurements is of great diagnostic and prognostic relevance. However, there is variability of zero leveling procedures, and the current recommendation of end-expiratory reading may not always be adequate. A review of physiological and anatomical data, supported by recent imaging, leads to the practical recommendation of zero leveling at the cross-section of three transthoracic planes, which are, respectively midchest frontal, transverse through the fourth intercostal space, and midsagittal. As for the inevitable respiratory pressure swings, end-expiratory reading at functional residual capacity allows for minimal influence of elastic lung recoil on pulmonary pressure reading. However, hyperventilation is associated with changes in end-expiratory lung volume and increased intrathoracic pressure, eventually exacerbated by expiratory muscle contraction and dynamic hyperinflation, all increasing pulmonary vascular pressures. This problem is amplified in patients with obstructed airways. With the exception of dynamic hyperinflation states, it is reasonable to assume that negative inspiratory and positive expiratory intrathoracic pressures cancel each other out, so averaging pulmonary vascular pressures over several respiratory cycles is most often preferable. This recommendation may be generalized for the purpose of consistency and makes sense, as pulmonary blood flow measurements are not corrected for phasic inspiratory and expiratory changes in clinical practice.
- Find related publications in this database (using NLM MeSH Indexing)
- Airway Resistance - physiology
- Cardiac Catheterization - methods
- Heart Failure - diagnosis
- Humans -
- Hypertension, Pulmonary - diagnosis
- Lung Volume Measurements - methods
- Prognosis -
- Pulmonary Disease, Chronic Obstructive - physiopathology
- Pulmonary Wedge Pressure - physiology
- Find related publications in this database (Keywords)
- right heart catheterization
- pulmonary artery pressure
- pulmonary hypertension
- zero reference level
- dynamic hyperinflation