Pulmonary wedge pressure
The pulmonary capillary wedge pressure or PCWP (also called the pulmonary wedge pressure or PWP, or pulmonary artery occlusion pressure or PAOP) is the pressure measured by wedging a pulmonary catheter with an inflated balloon into a small pulmonary arterial branch.1
Physiologically, distinctions can be drawn among pulmonary venous pressure, pulmonary artery pressure, pulmonary capillary wedge pressure, and left atrial pressure, but not all of these can be measured in a clinical context.2
Noninvasive estimation techniques have been proposed.3
Clinical significance
| Site | Normal pressure range (in mmHg)4 |
|
|---|---|---|
| Central venous pressure | 3–8 | |
| Right ventricular pressure | systolic | 15–30 |
| diastolic | 3–8 | |
| Pulmonary artery pressure | systolic | 15–30 |
| diastolic | 4–12 | |
| Pulmonary vein/ Pulmonary capillary wedge pressure |
2–15 | |
| Left ventricular pressure | systolic | 100–140 |
| diastolic | 3-12 | |
Because of the large compliance of the pulmonary circulation, it provides an indirect measure of the left atrial pressure.5
For example, it is considered the gold standard for determining the cause of acute pulmonary edema; this is likely to be present at a PCWP of >20mmHg. It has also been used to diagnose severity of left ventricular failure and mitral stenosis,6 given that elevated pulmonary capillary wedge pressure strongly suggests failure of left ventricular output.7
Pulmonary edema with normal PCWP suggest a diagnosis of acute respiratory distress syndrome (ARDS) or non cardiogenic pulmonary oedema (as in opiate poisoning) .
Physiological pressure: 6–12 mm Hg.8
References
- ^ Peacock, Andrew J.; Lewis J. Rubin (2004). Pulmonary Circulation: Diseases and their treatment. Arnold Publisher. ISBN 0-340-80782-2.
- ^ Chaliki HP, Hurrell DG, Nishimura RA, Reinke RA, Appleton CP (July 2002). "Pulmonary venous pressure: relationship to pulmonary artery, pulmonary wedge, and left atrial pressure in normal, lightly sedated dogs". Catheter Cardiovasc Interv 56 (3): 432–8. doi:10.1002/ccd.10203. PMID 12112902.
- ^ Uzun M, Erinc K, Kirilmaz A, et al. (November 2004). "A novel method to estimate pulmonary artery wedge pressure using the downslope of the Doppler mitral regurgitant velocity profile". Echocardiography 21 (8): 673–9. doi:10.1111/j.0742-2822.2004.03174.x. PMID 15546367.
- ^ Table 30-1 in: Trudie A Goers; Washington University School of Medicine Department of Surgery; Klingensmith, Mary E; Li Ern Chen; Sean C Glasgow (2008). The Washington manual of surgery. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. ISBN 0-7817-7447-0.
- ^ "Gun Shot Wound Case Study Discussion". Retrieved 2009-03-02.
- ^ "CV Physiology".
- ^ Harrison's Principles of Internal Medicine. 14th edition. Chapter 38, page 243.
- ^ "Pulmonary Capillary Wedge Pressure".
External links
- -1113980888 at GPnotebook
- Overview at cvphysiology.com
- Description at virginia.edu
- Pulmonary wedge pressure at the US National Library of Medicine Medical Subject Headings (MeSH)
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