Abstract
In the absence of a direct method with which to measure pulmonary capillary pressure in humans, various methods for analyzing the pulmonary artery pressure decay following balloon occlusion have been described. In this issue of Critical Care, Souza and coworkers investigate the adequacy of these methods for assessing various pathophysiological processes. They studied patients presenting with pathologies characterized by different distributions of pulmonary vascular resistance. Their findings suggest that no single method for estimating pulmonary capillary pressure is adequate for all disease processes.
Highlights
In healthy individuals pulmonary vascular resistance is low and is mostly located within the pulmonary arterial bed
Pulmonary arterial occlusion pressure may be used as a surrogate for the pressure determining filtration from the capillaries to the interstitium (PCP)
This is no longer the case when pulmonary venous resistance is increased, as may occur in pulmonary hypertension of various aetiologies, acute lung injury (ALI) and acute respiratory distress syndrome (ARDS). In these patients pulmonary capillary pressure (PCP) must be estimated by analyzing the pulmonary arterial pressure decay after pulmonary artery occlusion
Summary
In healthy individuals pulmonary vascular resistance is low and is mostly located within the pulmonary arterial bed. In the absence of significant venous resistance, pulmonary capillary pressure (PCP) is very close to the pulmonary arterial occlusion pressure. This is no longer the case when pulmonary venous resistance is increased, as may occur in pulmonary hypertension of various aetiologies, acute lung injury (ALI) and acute respiratory distress syndrome (ARDS).
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