Ebook Hemodynamic monitoring in the ICU: Part 2
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Ebook Hemodynamic monitoring in the ICU: Part 2
Hemodynamic Monitoring Techniques33.1Measurement of Pulmonary Artery Occlusion Pressure by the Pulmonary Artery Catheter3.1.1PrinciplePulmonary arteri Ebook Hemodynamic monitoring in the ICU: Part 2ial pressure (PAP) is measured at the distal end of the Swan-Ganz catheter. A transient occlusion of blood flow is performed during inflation of the distal balloon in a large caliber pulmonary artery. Beyond the balloon, the pressure drops in the pulmonary artery to a pressure called the pulmonary a Ebook Hemodynamic monitoring in the ICU: Part 2rtery occlusion pressure (PAOP) (Fig. 3.1). This pressure is (he same throughout the pulmonary vascular segment in which the balloon is occluded. ThisEbook Hemodynamic monitoring in the ICU: Part 2
segment behaves as an open downstream static column of blood in the pulmonary venous segment. In this regard, the PAOP is a reflection of the pulmonaHemodynamic Monitoring Techniques33.1Measurement of Pulmonary Artery Occlusion Pressure by the Pulmonary Artery Catheter3.1.1PrinciplePulmonary arteri Ebook Hemodynamic monitoring in the ICU: Part 2er. Because the resistance of the pulmonary venous segment flowing into the left atrium is considered to be low', the PAOP is a good reflection of the pressure of the left atrium and. by extension, the diastolic pressure of the left ventricle, provided that there is no mitral stenosis. Notably, the Ebook Hemodynamic monitoring in the ICU: Part 2PAOP does not match the pulmonary artery' wedge pressure. The wedge pressure corresponds to the pressure in relation to the occlusion of a pulmonary vEbook Hemodynamic monitoring in the ICU: Part 2
essel of a smaller caliber obtained withoutinflating the balloon. Thus, (he wedge pressure reflects the pulmonary venous pressure in an area with a loHemodynamic Monitoring Techniques33.1Measurement of Pulmonary Artery Occlusion Pressure by the Pulmonary Artery Catheter3.1.1PrinciplePulmonary arteri Ebook Hemodynamic monitoring in the ICU: Part 2 from the decay curve upon balloon inflation or from the Gaar equation, as follows:Pulmonary capillary' pressure = PAOP + 0.4 x(PAP„„,-PAOP)Unfortunately, this formula is only relevant if the venous resistance is homogeneously distributed. Pulmonary capillary pressure is rarely used in clinical prac Ebook Hemodynamic monitoring in the ICU: Part 2tice due to the difficulty of measurement. even though it reliably reflects the risk of pulmonary' edema.3.1.2Validity of the MeasurementIt is essentiEbook Hemodynamic monitoring in the ICU: Part 2
al that the intravascular pressure measurement is performed with the utmost care. The reference level during the measurement is the level of the rightHemodynamic Monitoring Techniques33.1Measurement of Pulmonary Artery Occlusion Pressure by the Pulmonary Artery Catheter3.1.1PrinciplePulmonary arteri Ebook Hemodynamic monitoring in the ICU: Part 2n accurate readings. The choice of zero reference level strongly influences pulmonary pressure readings and pulmonary hypertension classification. One-third of the thoracic diameter best represents the right atrium, while the mid-thoracic level best represents the left© Springer International Publis Ebook Hemodynamic monitoring in the ICU: Part 2hing Switzerland 2016R. Giraud, K. Bendjelid. Hemodynamic Monitoring in the ICU. DOI 10.1007/978-3-319-2943O-8_343https: //k hot h u vien .com443 HemoEbook Hemodynamic monitoring in the ICU: Part 2
dynamic Monitoring Techniques30Balloon inflation552545152010PAOP35End of expirium25IAAAAAA15505TimeFig. 3.1 Measurement of the PAOP from a pulmonary aHemodynamic Monitoring Techniques33.1Measurement of Pulmonary Artery Occlusion Pressure by the Pulmonary Artery Catheter3.1.1PrinciplePulmonary arteri Ebook Hemodynamic monitoring in the ICU: Part 2d be conducted in one step by always occurring with the patient lying in the recumbent position. However, they represent two separate processes: zeroing involves opening the system to the air to establish the atmospheric pressure as zero, and referencing (or leveling) is accomplished by placing the Ebook Hemodynamic monitoring in the ICU: Part 2air-fluid interface of the catheter or transducer at a specific point to negate the effects of the weight of the catheter tubing and fluid column [2 JEbook Hemodynamic monitoring in the ICU: Part 2
. The system can be referenced by placing the airfluid interface of either the in-line stopcock or the stopcock that is on top of the transducer at thHemodynamic Monitoring Techniques33.1Measurement of Pulmonary Artery Occlusion Pressure by the Pulmonary Artery Catheter3.1.1PrinciplePulmonary arteri Ebook Hemodynamic monitoring in the ICU: Part 2 posterior surfaces of the chest and a transverse plane lying at the junction of the fourth intercostal space and the sternal margin. Notably, this "phlebostalic level" changes with differences in the position of the patient [3|. This level remains the same regardless of the patient’s position in be Ebook Hemodynamic monitoring in the ICU: Part 2d (sitting or supine), but it is essential that no lateral rotation occurs. Moreover, it is often difficult to achieve these measures when the patientEbook Hemodynamic monitoring in the ICU: Part 2
is in the prone position.There is a change in intravascular pressure with respiration. During normal spontaneous ventilation. alveolar pressure (relaHemodynamic Monitoring Techniques33.1Measurement of Pulmonary Artery Occlusion Pressure by the Pulmonary Artery Catheter3.1.1PrinciplePulmonary arteri Ebook Hemodynamic monitoring in the ICU: Part 2ion: alveolar pressure increases during inspiration and decreases during expiration. The changes in pleural pressure are transmitted to the cardiac structures and are reflected by changes in pulmonary artery and PAOP measurements during inspiration and expiration. Ebook Hemodynamic monitoring in the ICU: Part 2Hemodynamic Monitoring Techniques33.1Measurement of Pulmonary Artery Occlusion Pressure by the Pulmonary Artery Catheter3.1.1PrinciplePulmonary arteriGọi ngay
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