Thursday December 1, 2005
Pulmonary Artery Occlusion Pressure and PEEP

There are 3 ways to correct/manage pulmonary artery occlusion pressure or pulmonary capillary wedge pressure (PCWP) in patients with PEEP (positive end-expiratory pressure) over 10.

1. Follow the trend of PCWP co-relating with other clinical data and interventions.

2. Corrected PCWP = Measured PCWP - .5 x (PEEP/1.36)
e.g. If measured PCWP is 20 and applied PEEP is 16:
Corrected PCWP = 20 - .5 (16/1.36) = 14.12

3. Corrected PCWP = measured PCWP - esophageal pressure.

Temporary discontinuation of PEEP to measure PCWP is not safe and should be avoided.

References: click to get abstract/article
1. Influence of positive end-expiratory pressure on left ventricular performance - NEJM, Feb. 1981, Volume 304:387-392
2. Monitoring Pulmonary Artery Pressure - Crit Care Nurse 2004 Jun;24(3):67-70
3. Measuring Intra-Esophageal Pressure to Assess Transmural Pulmonary Arterial Occlusion Pressure in Patients with Acute Lung Injury: A Case Series and Review - Respir Care 2000;45(9):1072-1084
4. Swan-Ganz Catheterization - online emedicine.com