Pulmonary artery catheterization: Interpretation of tracings
- Frank E Silvestry, MD
Frank E Silvestry, MD
- Associate Professor of Medicine
- Hospital of the University of Pennsylvania
The flow-directed pulmonary artery catheter (ie, Swan-Ganz catheter) permits the clinician to measure pressures and sample blood from the right atrium, right ventricle, and pulmonary artery [1,2]. It can also estimate the left atrial pressure by measuring the pulmonary artery wedge pressure (also called the pulmonary capillary wedge pressure or pulmonary artery occlusion pressure). This involves inflating a balloon at the tip of the catheter, allowing the balloon to occlude a branch of the pulmonary artery, and then measuring the pressure during occlusion.
Pulmonary artery catheterization can be used for a variety of clinical purposes. It can differentiate among the types of shock, identify etiologies of respiratory and cardiac failure, and diagnose and manage a range of conditions in critically ill patients (table 1). In addition, inspection of the pressure waveforms can detect cardiac tamponade, cardiac constriction, restrictive cardiomyopathy, mitral valvular regurgitation, tricuspid valvular regurgitation, intracardiac shunts (eg, atrial or ventricular septal defects), mechanical events related to the atria and ventricles, and intravascular volume status.
The interpretation of pulmonary artery catheter pressure tracings is described here. The effect of invasive hemodynamic monitoring on clinical outcomes is discussed separately, as are the insertion technique, indications, and complications. (See "Pulmonary artery catheters: Insertion technique in adults" and "Pulmonary artery catheterization: Indications, contraindications, and complications in adults".)
ZEROING AND REFERENCING
The pulmonary artery catheter must be appropriately zeroed and referenced to obtain accurate diagnostic information . Zeroing and referencing are done in one step, but they represent two separate processes:
●Zeroing involves opening the system to the air to establish atmospheric pressure as zero.
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- ZEROING AND REFERENCING
- PLACEMENT OF THE CATHETER
- ASSESSMENT OF THE DYNAMIC RESPONSE
- PRESSURE WAVEFORMS
- Right atrial waveform
- Right ventricular waveform
- Pulmonary artery waveform
- Pulmonary artery wedge pressure waveform
- - Lung zones
- - Respiratory effects
- - Positive end-expiratory pressure
- CALCULATION OF CARDIAC OUTPUT
- Indicator dilution method
- - Newer catheters
- Fick method
- DETECTION OF LEFT TO RIGHT SHUNTS
- SUMMARY AND RECOMMENDATIONS