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A noninvasive method of predicting pulmonary-capillary wedge pressure
K M McIntyre1, J A Vita, C T Lambrew
1Department of Medicine, Brockton-West Roxbury Veterans Affairs Medical Center, MA 02132.
The New England Journal of Medicine
|December 10, 1992
Summary
A new noninvasive method accurately predicts pulmonary-capillary wedge pressure (PCWP) using the Valsalva maneuver's pulse-amplitude ratio. This bedside technique is valuable for managing cardiovascular disorders.
Area of Science:
- Cardiology
- Physiology
- Medical Devices
Background:
- Accurate pulmonary-capillary wedge pressure (PCWP) measurement is crucial for diagnosing and managing cardiovascular diseases.
- Current methods for PCWP measurement are invasive, posing risks to patients.
- The arterial pressure response during the Valsalva maneuver shows a correlation with PCWP.
Purpose of the Study:
- To develop and validate a noninvasive bedside method for predicting PCWP.
- To assess the correlation between a novel pulse-amplitude ratio and directly measured PCWP.
Main Methods:
- A noninvasive pulse-amplitude ratio was measured during the Valsalva maneuver.
- Direct PCWP measurements were obtained using a pulmonary-artery catheter simultaneously.
- Measurements were performed on both clinically stable and unstable patients, some with endotracheal tubes.
Main Results:
- The pulse-amplitude ratio strongly correlated with measured PCWP (R2 = 0.80 in stable, R2 = 0.85 in unstable patients).
- The method accurately predicted PCWP changes following medical interventions like nitroglycerin, furosemide, and volume expansion (R2 = 0.79).
Conclusions:
- A simple, noninvasive method effectively predicts PCWP at the bedside.
- This technique shows promise for accurately monitoring PCWP and its response to therapy.