Page 321 - Clinical Application of Mechanical Ventilation

Hemodynamic Monitoring 287

A RA
40–
mm Hg

0–

B RV
40–

0–

C PA
40–

0–

D PCW
40–

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0–

Figure 10-8 Waveform characteristics during advancement of pulmonary artery catheter.
(A) Right atrium (RA) and right atrial (central venous) waveform; (B) Right ventricle (RV) and right
ventricular waveform; (C) Pulmonary artery (PA) and pulmonary arterial waveform; and (D) Pulmo-
nary capillary wedge (PCW) and pulmonary capillary wedge pressure waveform.

a systolic pulmonary artery pressure of .35 mm Hg or a mean pulmonary artery
Pulmonary hypertension pressure of .25 mm Hg at rest or .30 mm Hg with exertion (McGoon et al., 2004).
is defined as a systolic PAP
.35 mm Hg, or mean PAP When positive pressure ventilation is augmented with positive end-expiratory
.25 mm Hg at rest (. 30 mm pressure (PEEP), the PAP is increased because overdistension of the alveoli com-
Hg with exertion).
presses the surrounding capillaries and raises the capillary and arterial pressures
(Versprille, 1990). Increase in pulmonary vascular resistance or pulmonary blood
flow can also lead to an increased PAP, because the pressure measurement is directly
related to the resistance and blood flow.
A higher than normal PAP may also be seen in left ventricular dysfunction such as
left ventricular failure and mitral valve disease. This is because obstruction or backup

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