Table 2 Clinical meanings and usefulness of various PAC-derived haemodynamic variables in different clinical conditions
From: Which cardiac surgical patients can benefit from placement of a pulmonary artery catheter?
Clinical scenario | Useful PAC-derived indices | Clinical meaning/uses |
|---|---|---|
Impaired left ventricular systolic function | CI | Clinical target (i.e. >2.4 l/min per m2) |
Monitor effects of inotropic therapy | ||
Monitor fluid responsiveness | ||
PCWP | Left ventricular filling pressure | |
Monitor fluid responsiveness | ||
Monitor effects of inotropic/vasodilating therapy | ||
PAP | Check for the presence of pre-capillary or post-capillary pulmonary hypertension | |
Possible use as continuous index of left ventricular preload | ||
SVR | Check for the presence of a peripheral vasoconstrictive status | |
SvO2 | Monitor the effects of vasodilating therapies | |
Clinical target (i.e. >75%) | ||
Check matching of DO2 to VO2 | ||
Monitor adequacy of CI | ||
Monitor the effects of drug and fluid administration | ||
Impaired right ventricular function | CI | As above |
SvO2 | As above | |
PCWP | As above | |
CVP | RV preload and venous system filling status | |
Monitor fluid responsiveness | ||
PVR | Check for the presence of pulmonary hypertension | |
Guide inhaled nitric oxide therapy and ventilator settings | ||
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 | ||
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 | ||
Right ventricular EF | Right ventricular contractility and preload | |
RVEDV | ||
SvO2 | Adequacy of LVAD flow to the metabolic needs |