Wedge Pressure Measurement in Obstructive Pulmonary Disease

Rice, David L.; Awe, Robert J.; Gaasch, William H.; Alexander, James; Jenkins, Daniel E.

doi:10.1378/chest.66.6.628

Cited by 47 publications

(27 citation statements)

References 12 publications

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“…In the healthy population, the use of expiratory muscles can lead to substantial positive intrathoracic pressure as well, albeit only at maximal exercise [28]. Pulmonary vascular pressure, therefore, should be averaged over two to three respiratory cycles, not only in COPD [7,8,29], but also healthy subjects [11][12][13]. Whether mPAPaveraged is a more accurate estimate of the intravascular pressure at maximal exercise in this population remains unknown, and depends on the amplitude and the length of the inspiratory and expiratory excursions in intrathoracic pressure.…”

Section: Discussionmentioning

confidence: 99%

Measuring central pulmonary pressures during exercise in COPD: how to cope with respiratory effects

et al. 2013

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Respiratory influences are major confounders when evaluating central haemodynamics during exercise. We studied four different methods to assess mean pulmonary artery pressure (mPAP) and pulmonary capillary wedge pressure (PCWP) in cases of respiratory swings.Central haemodynamics were measured simultaneously with oesophageal pressure during exercise in 30 chronic obstructive pulmonary disease (COPD) patients. mPAP and PCWP were assessed at the end of expiration, averaged over the respiratory cycle and corrected for the right atrial pressure (RAP) waveform estimated intrathoracic pressure, and compared with the transmural pressures.Bland-Altman analyses showed the best agreement of mPAP averaged over the respiratory cycle (bias (limits of agreement) 2.5 (-6.0-11.8) mmHg) and when corrected with the nadir of RAP (-3.6 (-11.2-3.9) mmHg). Measuring mPAP at the end of expiration (10.3 (0.5-20.3) mmHg) and mPAP corrected for the RAP swing (-9.3 (-19.8-2.1) mmHg) resulted in lower levels of agreement. The respiratory swings in mPAP and PCWP were similar (r 2 50.82, slope¡SE 0.95¡0.1). Central haemodynamics measured at the end of expiration leads to an overestimation of intravascular pressures in exercising COPD patients. Good measurement can be acquired even when oesopghageal pressure is omitted, by averaging pressures over the respiratory cycle or using the RAP waveform to correct for intrathoracic pressure. Assessment of the pulmonary gradient is unaffected by respiratory swings. @ERSpublications Measurement of intravascular pressures in exercising COPD patients requires correction for intrathoracic pressure

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Section: Discussionmentioning

confidence: 99%

Measuring central pulmonary pressures during exercise in COPD: how to cope with respiratory effects

et al. 2013

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“…In the study of HILDE et al [6], PCWP was on average normal at rest, but increased markedly at exercise, in patients with, as well as without, pulmonary hypertension. It has been previously shown that in patients with COPD, PCWP and PAP increase at rest and more so at exercise, along with oesophageal pressures, in relation to dynamic hyperinflation and expiratory muscle contraction [14][15][16]. Therefore, pulmonary vascular pressures may actually increase with intrathoracic pressure becoming higher than reference atmospheric pressure, although a direct compression of the heart may also occur, thereby further increasing left ventricular end-diastolic pressure [14][15][16].…”

mentioning

confidence: 99%

“…It has been previously shown that in patients with COPD, PCWP and PAP increase at rest and more so at exercise, along with oesophageal pressures, in relation to dynamic hyperinflation and expiratory muscle contraction [14][15][16]. Therefore, pulmonary vascular pressures may actually increase with intrathoracic pressure becoming higher than reference atmospheric pressure, although a direct compression of the heart may also occur, thereby further increasing left ventricular end-diastolic pressure [14][15][16]. As illustrated in figure 1, intrathoracic pressure swings in patients with COPD may be huge, but are more positive than negative.…”

mentioning

confidence: 99%

“…Pulmonary vascular pressures used to be averaged over two to three respiratory cycles, rather than measured only at endexpiration as currently recommended [14][15][16]. In the study by HILDE et al [6], pulmonary vascular pressures were measured at end-expiration and the authors even added a temporary breath-hold.…”

mentioning

confidence: 99%

“…However, the question remains as to whether it makes ''physiological'' sense to read PAP and PCWP exclusively at the moment when intrathoracic pressure is highest. It may be more sensible to subtract oesophageal pressures from pulmonary vascular pressures for a realistic evaluation of the pulmonary circulation in the presence of marked variations in intrathoracic pressures [14][15][16].…”

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confidence: 99%

See 2 more Smart Citations

Pulmonary hypertension at exercise in COPD: does it matter?

Naeije

Boerrigter

2013

Eur Respir J

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Pulmonary vascular pressure respiratory swings in COPD and ILD candidates for lung transplantation: Large but different

Grignola,

Calabuig,

Trujillo

et al. 2024

Pulm. circ.

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We analyzed the effect of respiratory swings on interpreting intravascular pulmonary vascular pressures (PVPs) in chronic obstructive pulmonary disease (COPD) and interstitial lung disease (ILD) candidates for lung transplantation (LTx) and the role of the alterations in pulmonary function tests on the dynamic respiratory variations. Twenty‐eight consecutive patients were included. All patients underwent a complete hemodynamic study (right atrial, mean pulmonary arterial, and pulmonary arterial occlusion pressures [RAP, mPAP, and PAOP]‐) and pulmonary function testing (force vital capacity [FVC], forced expiratory volume in the first second [FEV1], and residual volume [RV]). A subgroup of 10 patients underwent simultaneous esophageal pressure (PES). All hemodynamic parameters and PES were collected during apnea after an unforced expiration (ee) and during spontaneous breathing averaging five respiratory cycles (mrc). The respiratory swing (osc) was estimated as the difference between maximum–minimum values of pressures during the respiratory cycle. Intravascular RAPee, mPAPee, and PAOPee were higher than mrc values (p < 0.05), leading to 11% of pulmonary hypertension (PH) misdiagnosis and 37% of postcapillary PH misclassification. PAOPosc of COPD was higher than ILD patients and RAPosc (p < 0.05). Only PAOPosc correlated with FVC, FEV1, and RV (p < 0.05). ILD PESmrc was lower than COPD (p < 0.05), and it was associated with a significantly higher transmural than intravascular RAPmrc, mPAPmrc, and PAOPmrc. PESmrc was significantly correlated with FVC. Transmural mPAPmrc and PAOPmrc readings determined around 20% of reclassification of the patients compared to ee measurements. Candidates for LTx showed large respiratory swings in PVP, which were correlated with pulmonary function alterations. mrc PVP would be more closely approximated to the true transmural PVP leading to PH reclassification. Adjusting PVP for PES should be considered in COPD and ILD candidates of LTx with severe alterations in pulmonary functional tests and suspicion of a PESmrc far from 0. PES respiratory swings could be different in ILD to COPD patients.

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Wedge Pressure Measurement in Obstructive Pulmonary Disease

Cited by 47 publications

References 12 publications

Measuring central pulmonary pressures during exercise in COPD: how to cope with respiratory effects

Measuring central pulmonary pressures during exercise in COPD: how to cope with respiratory effects

Pulmonary hypertension at exercise in COPD: does it matter?

Pulmonary vascular pressure respiratory swings in COPD and ILD candidates for lung transplantation: Large but different

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