The measurement of venous pressure by the direct method

Lyons, Richard H.; Kennedy, J. A.; Burwell, Cathy

doi:10.1016/s0002-8703(38)90950-0

Cited by 85 publications

(23 citation statements)

References 42 publications

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“…This point may be found at the junction of ''phlebostatic levels'' [14] and was supposed to be within the right atrium or in the right ventricle next to the tricuspid valve, but in any case at the level of the right atrium in the supine patient. Accordingly, it has been widely accepted that in the case of PAP and venous pressure measurements, the ideal ZRL should be set at the level of the right atrium [6,9,[15][16][17]. However, in the search for the optimal ZRL, it may also be adequate to refer to the level of the left atrium [18,19], particularly if the diastolic function of the left ventricle is to be analysed.…”

Section: Where Is the Ideal Zrl?mentioning

confidence: 99%

“…According to most studies, the ZRL was set at 5 cm below the surface of the thorax. The method was mainly criticised because in individuals with large thoracic diameters this ZRL may be too high, resulting in too low pressure readings [9]. …”

Section: Where Is the Ideal Zrl?mentioning

confidence: 99%

“…According to the published literature, the ZRL is generally recommended to be set at the level of the right atrium, or at the level of the tricuspid valve, based on the concept of the ''hydrostatic indifferent point'' representing a location in the circulatory system at which gravitational pressure factors caused by changes in body position do not much affect the pressure measurements [5]. In practice, the most frequently used ZRLs in the supine patient are at 5 cm below the anterior thorax surface [6], at 1/3 of the thoracic diameter below the anterior thorax surface [7], at the midthoracic level [8] and 10 cm above table level [9]. Nevertheless, there are also arguments for setting the ZRL at the level of the left atrium, particularly if left heart pressures and the distinction between pre-and postcapillary PH are the focus of interest.…”

Section: Introductionmentioning

confidence: 99%

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Zero reference level for right heart catheterisation

Kovàcs

Avian²,

Olschewski³

et al. 2013

Eur Respir J

134

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Although in the pulmonary circulation small pressure differences may alter the categorisation of patients, there is no consensus on a standard zero reference level (ZRL). In the supine position, ZRL is mostly set at ''5 cm below anterior thorax surface'', ''1/3 thoracic diameter below anterior thorax surface'', ''mid-thoracic level'' or ''10 cm above table level''.We retrospectively assessed the distance of these four ZRLs from computed tomography-derived right and left atrial centre levels and from one another in patients undergoing right heart catheterisation and calculated the respective differences in pressure readings.We included 196 consecutive patients. The ZRL at ''1/3 thoracic diameter'' was most often (98.5%) level with the right atrium, and the ZRL at ''mid-thoracic level'' was level with the left atrium (97.4%), revealing a median (range) pressure difference of -0.3 (-3.0-1.3) and 0.2 (-2.0-1.3) mmHg from the right and left atrial centre level, respectively. The largest differences (8.0 (2.0-15.4) mmHg) were found between the ZRLs ''5 cm below anterior thorax surface'' and ''10 cm above table level''. Accordingly, 59% versus 80% of patients would be classified with pulmonary hypertension and 7% versus 38% with elevated left heart pressures.The choice of ZRL strongly influences pulmonary pressure readings and pulmonary hypertension classification. 1/3 thoracic diameter mostly represents the right atrium while the left atrium is best represented by the mid-thoracic level. @ERSpublications Choice of pulmonary circulation zero reference level influences classification of pulmonary hypertension

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Section: Where Is the Ideal Zrl?mentioning

confidence: 99%

Section: Where Is the Ideal Zrl?mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Zero reference level for right heart catheterisation

Kovàcs

Avian²,

Olschewski³

et al. 2013

Eur Respir J

134

View full text Add to dashboard Cite

show abstract

“…It likewise varies with systole and diastole. Until a standard reference level has been agreed upon, we have chosen to use the level described by one of us (18), which is 10 cm. anterior to the skin of the back with the subject in the supine position.…”

Section: Discussionmentioning

confidence: 99%

Studies of Congenital Heart Disease. I. Technique of Venous Catheterization as a Diagnostic Procedure 1

Dexter¹,

Haynes²,

Burwell³

et al. 1947

J. Clin. Invest.

106

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“…As noted previously, the zero point for all pressures was taken as 10 cm. anterior to the skin of the back with the patient in the supine position (5).…”

Section: Methodsmentioning

confidence: 99%