- Section 1 ICU organization and management
- Section 2 Pharmacotherapeutics
- Section 3 Resuscitation
- Section 4 The respiratory system
- Section 5 The cardiovascular system
- Part 5.1 Physiology
- Part 5.2 Cardiovascular monitoring
- Chapter 129 ECG monitoring in the ICU
- Chapter 130 Arterial and venous cannulation in the ICU
- Chapter 131 Blood pressure monitoring in the ICU
- Chapter 132 Central venous pressure monitoring in the ICU
- Chapter 133 Pulmonary artery catheterization in the ICU
- Chapter 134 Mixed and central venous oxygen saturation monitoring in the ICU
- Chapter 135 Right ventricular function in the ICU
- Chapter 136 Cardiac output assessment in the ICU
- Chapter 137 Oxygen transport in the critically ill
- Chapter 138 Tissue perfusion monitoring in the ICU
- Chapter 139 Lactate monitoring in the ICU
- Chapter 140 Measurement of extravascular lung water in the ICU
- Chapter 141 Doppler echocardiography in the ICU
- Chapter 142 Monitoring the microcirculation in the ICU
- Chapter 143 Imaging the cardiovascular system in the ICU
- Part 5.3 Acute chest pain and coronary syndromes
- Part 5.4 Aortic dissection
- Part 5.5 The hypotensive patient
- Part 5.6 Cardiac failure
- Part 5.7 Tachyarrhythmias
- Part 5.8 Bradyarrhythmias
- Part 5.9 Valvular problems
- Part 5.10 Endocarditis
- Part 5.11 Severe hypertension
- Part 5.12 Severe capillary leak
- Part 5.13 Pericardial tamponade
- Part 5.14 Pulmonary hypertension
- Part 5.15 Pulmonary embolus
- Section 6 The gastrointestinal system
- Section 7 Nutrition
- Section 8 The renal system
- Section 9 The neurological system
- Section 10 The metabolic and endocrine systems
- Section 11 The haematological system
- Section 12 The skin and connective tissue
- Section 13 Infection
- Section 14 Inflammation
- Section 15 Poisoning
- Section 16 Trauma
- Section 17 Physical disorders
- Section 18 Pain and sedation
- Section 19 General surgical and obstetric intensive care
- Section 20 Specialized intensive care
- Section 21 Recovery from critical illness
- Section 22 End-of-life care
(p. 618) Pulmonary artery catheterization in the ICU
- Chapter:
- (p. 618) Pulmonary artery catheterization in the ICU
- Author(s):
Efrat Orenbuch-Harroch
and Charles L. Sprung
- DOI:
- 10.1093/med/9780199600830.003.0133
Haemodynamic monitoring is a significant component in the management of critically-ill patients. Flow-directed pulmonary artery catheters (PAC) are a simple and rapid technique for measuring several continuous or intermittent circulatory variables. The PAC is helpful in diagnosis, guidance of therapy, and monitoring therapeutic interventions in various clinical conditions, including myocardial infarction and its complications, non-cardiogenic pulmonary oedema and severely ill patients.The catheter is inserted through a large vein. The PAC is advanced, after ballooninflation with 1.5 mL of air, through the right ventricle across the pulmonary valve and into the pulmonary artery (PA). Finally, the catheter is advanced to the ‘wedge’ position. The pulmonary artery wedge pressure (PAWP) is identified by a decrease in pressure combined with a characteristic change in the waveform. The balloon should then be deflated and the PA tracing should reappear. Direct measurements include central venous pressure, pulmonary artery pressure, and PAWP, which during diastole represents the left ventricular end-diastolic pressure and reflects left ventricular preload. Cardiac output can be measured by thermodilution technique. Other haemodynamic variables can be derived from these measurements. Absolute contraindications are rare. Relative contraindications include coagulopathy and conditions that increase the risk of arrhythmias.
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- Section 1 ICU organization and management
- Section 2 Pharmacotherapeutics
- Section 3 Resuscitation
- Section 4 The respiratory system
- Section 5 The cardiovascular system
- Part 5.1 Physiology
- Part 5.2 Cardiovascular monitoring
- Chapter 129 ECG monitoring in the ICU
- Chapter 130 Arterial and venous cannulation in the ICU
- Chapter 131 Blood pressure monitoring in the ICU
- Chapter 132 Central venous pressure monitoring in the ICU
- Chapter 133 Pulmonary artery catheterization in the ICU
- Chapter 134 Mixed and central venous oxygen saturation monitoring in the ICU
- Chapter 135 Right ventricular function in the ICU
- Chapter 136 Cardiac output assessment in the ICU
- Chapter 137 Oxygen transport in the critically ill
- Chapter 138 Tissue perfusion monitoring in the ICU
- Chapter 139 Lactate monitoring in the ICU
- Chapter 140 Measurement of extravascular lung water in the ICU
- Chapter 141 Doppler echocardiography in the ICU
- Chapter 142 Monitoring the microcirculation in the ICU
- Chapter 143 Imaging the cardiovascular system in the ICU
- Part 5.3 Acute chest pain and coronary syndromes
- Part 5.4 Aortic dissection
- Part 5.5 The hypotensive patient
- Part 5.6 Cardiac failure
- Part 5.7 Tachyarrhythmias
- Part 5.8 Bradyarrhythmias
- Part 5.9 Valvular problems
- Part 5.10 Endocarditis
- Part 5.11 Severe hypertension
- Part 5.12 Severe capillary leak
- Part 5.13 Pericardial tamponade
- Part 5.14 Pulmonary hypertension
- Part 5.15 Pulmonary embolus
- Section 6 The gastrointestinal system
- Section 7 Nutrition
- Section 8 The renal system
- Section 9 The neurological system
- Section 10 The metabolic and endocrine systems
- Section 11 The haematological system
- Section 12 The skin and connective tissue
- Section 13 Infection
- Section 14 Inflammation
- Section 15 Poisoning
- Section 16 Trauma
- Section 17 Physical disorders
- Section 18 Pain and sedation
- Section 19 General surgical and obstetric intensive care
- Section 20 Specialized intensive care
- Section 21 Recovery from critical illness
- Section 22 End-of-life care