Table 2 |
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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 |
|
|
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 |
|
|
Possible use as continuous index of left ventricular preload |
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|
SVR |
Check for the presence of a peripheral vasoconstrictive status |
|
|
SvO2 |
Monitor the effects of vasodilating therapies |
|
|
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 |
|
|
CVP |
RV preload and venous system filling status |
|
|
Monitor fluid responsiveness |
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|
PVR |
Check for the presence of pulmonary hypertension |
|
|
Guide inhaled nitric oxide therapy and ventilator settings |
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|
Right ventricular EF |
RV contractility index |
|
|
RV EDV |
RV preload |
|
|
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 |
|
|
Need for iNO therapy and monitor the effects |
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|
Right ventricular EF |
Right ventricular contractility and preload |
|
|
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. |
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Ranucci Critical Care 2006 10(Suppl 3):S6 doi:10.1186/cc4833 |
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