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Clinical meanings and usefulness of various PAC-derived haemodynamic variables in different clinical conditions |
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| Clinical scenario |
Useful PAC-derived indices |
Clinical meaning/uses |
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| Impaired left ventricular systolic function |
CI |
Clinical target (i.e. >2.4 l/min per m2) |
| Monitor effects of inotropic therapy |
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| Monitor fluid responsiveness |
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| PCWP |
Left ventricular filling pressure |
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| Monitor fluid responsiveness |
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| Monitor effects of inotropic/vasodilating therapy |
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| PAP |
Check for the presence of pre-capillary or post-capillary pulmonary hypertension |
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| Possible use as continuous index of left ventricular preload |
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| SVR |
Check for the presence of a peripheral vasoconstrictive status |
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| SvO2 |
Monitor the effects of vasodilating therapies |
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| Clinical target (i.e. >75%) |
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| Check matching of DO2 to VO2 |
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| Monitor adequacy of CI |
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| Monitor the effects of drug and fluid administration |
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| Impaired right ventricular function |
CI |
As above |
| SvO2 |
As above |
|
| PCWP |
As above |
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| CVP |
RV preload and venous system filling status |
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| Monitor fluid responsiveness |
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| PVR |
Check for the presence of pulmonary hypertension |
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| Guide inhaled nitric oxide therapy and ventilator settings |
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| Right ventricular EF |
RV contractility index |
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| RV EDV |
RV preload |
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| Left ventricular diastolic dysfunction |
CI |
As above |
| SvO2 |
As above |
|
| PCWP |
As above, with particular respect to fluid responsiveness and fluid administration |
|
| Follow changes from pseudo-normalization to restrictive pattern |
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| Acute ventricular septal defect |
CI |
Suggestive for VSD reopening after correction if increased |
| SvO2 |
Diagnostic for VSD reopening after correction if increased |
|
| LVAD |
CVP |
Right ventricular preload and general filling status of the patient |
| PVR |
Presence of pre-capillary pulmonary hypertension |
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| Need for iNO therapy and monitor the effects |
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| Right ventricular EF |
Right ventricular contractility and preload |
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| RVEDV |
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| SvO2 |
Adequacy of LVAD flow to the metabolic needs |
|
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CI, cardiac index; CVP, central venous pressure; DO2, oxygen delivery; EF, ejection fraction; LVAD, left ventricular assist device; PAC, pulmonary artery catheter; PAP, pulmonary artery pressure; PCWP, pulmonary capillary wedge pressure; PVR, pulmonary vascular resistances; RVEDV; right ventricle end-diastolic volume; SvO2, mixed venous oxygen saturation; SVR, systemic vascular resistances; VO2, oxygen consumption. | ||
Ranucci Critical Care 2006 10(Suppl 3):S6 doi:10.1186/cc4833 |
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