HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text (PDF) References Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Ray Chu-Jeng Chiu Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Wittnich, C. Articles by Chiu, R. C.-J. Search for Related Content PubMed PubMed Citation Articles by Wittnich, C. Articles by Chiu, R. C.-J.

Ann Thorac Surg 1986;42:192-196
© 1986 The Society of Thoracic Surgeons

---

Articles

Misleading "Pulmonary Wedge Pressure" after Pneumonectomy: Its Importance in Postoperative Fluid Therapy

McGill University and the Montreal General Hospital, Montreal, Quebec, Canada

Accepted for publication November 27, 1985.

^* Address reprint requests to Dr. Chiu, Montreal General Hospital, 1650 Cedar Ave, Room 947, Montreal, Quebec, Canada, H3G 1A4

Patients who have undergone pneumonectomy are reported to be at increased risk of serious pulmonary edema. Monitoring fluid therapy using the Swan-Ganz balloon-tipped catheter is therefore important in the perioperative management of these patients. Pulmonary artery occlusion pressure (PAOP), determined by inflating a balloon to occlude a branch of the pulmonary artery, is routinely used to measure pulmonary wedge pressure (PWP). In turn, PWP reflects left atrial pressure (LAP). We clinically observed postpneumonectomy patients in whom pulmonary edema developed, but whose PAOP was near normal. Our findings led us to suspect that PAOP in such patients may reflect a falsely low PWP value. We hypothesized that after pneumonectomy inflation of the balloon on the Swan-Ganz catheter to obtain PWP can result in considerable occlusion of the remaining cross-sectional area of pulmonary circulation. This occlusion acutely increases the right ventricular afterload, resulting in reduced cardiac output and reduced LAP. Although the PAOP under these circumstances still accurately reflects the LAP, these values have been artificially lowered; hence, they result in falsely low PWP readings. To verify this hypothesis, the following canine experiments were performed.

Five dogs were monitored with a Swan-Ganz catheter, a left atrial catheter, and an electromagnetic flow probe applied to a carotid artery. Before pneumonectomy, inflation of the balloon to obtain PAOP caused no statistically significant change in LAP or carotid flow, and PAOP was identical to both LAP and PWP. (PWP was determined by advancing and wedging the pulmonary artery catheter tip into a peripheral branch without inflating the balloon.) After pneumonectomy, however, balloon inflation reduced LAP and carotid flow. The PAOP obtained was significantly lower (p < .05, by paired t test) than the true LAP and PWP.

Our findings support our hypothesis that PAOP readings may be falsely low after pneumonectomy. This pitfall should be considered in the fluid management of pneumonectomy patients, and perhaps of other patients whose pulmonary vascular bed is severely compromised.

This article has been cited by other articles:

				K. P. Grichnik and T. A. D'Amico Acute Lung Injury and Acute Respiratory Distress Syndrome After Pulmonary Resection Seminars in Cardiothoracic and Vascular Anesthesia, December 1, 2004; 8(4): 317 - 334. [Abstract] [PDF]

				G. Della Rocca, G. M. Costa, C. Coccia, L. Pompei, P. Di Marco, and P. Pietropaoli Preload Index: Pulmonary Artery Occlusion Pressure Versus Intrathoracic Blood Volume Monitoring During Lung Transplantation Anesth. Analg., October 1, 2002; 95(4): 835 - 843. [Abstract] [Full Text] [PDF]

				N. M. Dietz Pathophysiology of Postpneumonectomy Pulmonary Edema Seminars in Cardiothoracic and Vascular Anesthesia, March 1, 2000; 4(1): 31 - 35. [Abstract] [PDF]

				C. A. Kutlu, E. A. Williams, T. W. Evans, U. Pastorino, and P. Goldstraw Acute lung injury and acute respiratory distress syndrome after pulmonary resection Ann. Thorac. Surg., February 1, 2000; 69(2): 376 - 380. [Abstract] [Full Text] [PDF]

				M. Aoe, K. Okabayashi, J. D. Cooper, and G. A. Patterson HYPERINFLATION OF CANINE LUNG ALLOGRAFTS DURING STORAGE INCREASES REPERFUSION PULMONARY EDEMA J. Thorac. Cardiovasc. Surg., July 1, 1996; 112(1): 94 - 102. [Abstract] [Full Text]

				G. J. Despotis, M. Karanikolas, A. N. Triantafillou, C. G. Pond, G. V. Kirvassilis, G. A. Patterson, J. D. Cooper, and D. G. Lappas Pressure gradient across the pulmonary artery anastomosis during lung transplantation Ann. Thorac. Surg., September 1, 1995; 60(3): 630 - 634. [Abstract] [PDF]

				M. Aoe, G. D. Trachiotis, K. Okabayashi, J. K. Manchester, O. H. Lowry, J. D. Cooper, and G. A. Patterson Administration of prostaglandin E1 after lung transplantation improves early graft function Ann. Thorac. Surg., September 1, 1994; 58(3): 655 - 661. [Abstract] [PDF]

				O. M. Shapira and D. M. Shahian Postpneumonectomy pulmonary edema Ann. Thorac. Surg., July 1, 1993; 56(1): 190 - 195. [Abstract] [PDF]

				D. A. Waller, C. Gebitekin, N. R. Saunders, and D. R. Walker Noncardiogenic pulmonary edema complicating lung resection Ann. Thorac. Surg., January 1, 1993; 55(1): 140 - 143. [Abstract] [PDF]

				M. E. Ward, H. Shennib, and A. Zidulka Hemodynamic effects of lobar pulmonary artery occlusion in a porcine sepsis model Ann. Thorac. Surg., March 1, 1991; 51(3): 451 - 454. [Abstract] [PDF]