肺動脈楔入圧 pulmonary capillary wedge pressure

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/09/05 21:41:52」(JST)

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Diagram of Pulmonary artery catheter

The pulmonary wedge pressure or PWP, or cross-sectional pressure (also called the pulmonary arterial wedge pressure or PAWP, pulmonary capillary wedge pressure or PCWP, pulmonary venous wedge pressure or PVWP, or pulmonary artery occlusion pressure or PAOP), is the pressure measured by wedging a pulmonary catheter with an inflated balloon into a small pulmonary arterial branch.^[1]

Physiologically, distinctions can be drawn among pulmonary artery pressure, pulmonary capillary wedge pressure, pulmonary venous pressure and left atrial pressure, but not all of these can be measured in a clinical context.^[2]

Noninvasive estimation techniques have been proposed.^[3]

Clinical significance

Site		Normal pressure range (in mmHg)^[4]
Central venous pressure		3–8
Right ventricular pressure	systolic	15–30
Right ventricular pressure	diastolic	3–8
Pulmonary artery pressure	systolic	15–30
Pulmonary artery pressure	diastolic	4–12
Pulmonary vein/ Pulmonary capillary wedge pressure		2–15
Left ventricular pressure	systolic	100–140
Left ventricular pressure	diastolic	3-12

Because of the large compliance of the pulmonary circulation^{[citation needed]}, it provides an indirect measure of the left atrial pressure.^[5]

For example, it is considered the gold standard for determining the cause of acute pulmonary edema; this is likely to be present at a PWP of >20mmHg. It has also been used to diagnose severity of left ventricular failure and mitral stenosis,^[6] given that elevated pulmonary capillary wedge pressure strongly suggests failure of left ventricular output.^[7]

Traditionally, it was believed that pulmonary edema with normal PWP suggested a diagnosis of acute respiratory distress syndrome (ARDS) or non cardiogenic pulmonary edema (as in opiate poisoning). However, since capillary hydrostatic pressure exceeds wedge pressure once the balloon is deflated (to promote a gradient for forward flow), a normal wedge pressure cannot conclusively differentiate between hydrostatic pulmonary edema and ARDS.

Physiological pressure: 6–12 mm Hg.^[8]

References

^ Peacock, Andrew J.; Lewis J. Rubin (2004). Pulmonary Circulation: Diseases and their treatment. Arnold Publisher. ISBN 0-340-80782-2.
^ Chaliki HP, Hurrell DG, Nishimura RA, Reinke RA, Appleton CP (July 2002). "Pulmonary venous pressure: relationship to pulmonary artery, pulmonary wedge, and left atrial pressure in normal, lightly sedated dogs". Catheter Cardiovasc Interv 56 (3): 432–8. doi:10.1002/ccd.10203. PMID 12112902.
^ Uzun M, Erinc K, Kirilmaz A et al. (November 2004). "A novel method to estimate pulmonary artery wedge pressure using the downslope of the Doppler mitral regurgitant velocity profile". Echocardiography 21 (8): 673–9. doi:10.1111/j.0742-2822.2004.03174.x. PMID 15546367.
^ Table 30-1 in: Trudie A Goers; Washington University School of Medicine Department of Surgery; Klingensmith, Mary E; Li Ern Chen; Sean C Glasgow (2008). The Washington manual of surgery. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. ISBN 0-7817-7447-0.
^ "Gun Shot Wound Case Study Discussion". Retrieved 2009-03-02.
^ "CV Physiology".
^ Harrison's Principles of Internal Medicine. 14th edition. Chapter 38, page 243.
^ "Pulmonary Capillary Wedge Pressure".

External links

-1113980888 at GPnotebook
Overview at cvphysiology.com
Description at virginia.edu
Pulmonary wedge pressure at the US National Library of Medicine Medical Subject Headings (MeSH)

UpToDate Contents

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1. 心臓カテーテル検査法：正常な血行動態 cardiac catheterization techniques normal hemodynamics
2. 肺動脈カテーテル法：トレーシングの解釈 pulmonary artery catheterization interpretation of tracings
3. 肺動脈カテーテル法：適応および合併症 pulmonary artery catheterization indications and complications
4. 心臓カテーテル検査で測定した弁膜疾患の血行動態 hemodynamics of valvular disorders as measured by cardiac catheterization
5. 非心原性肺水腫 noncardiogenic pulmonary edema

English Journal

Novel Parameter to Predict Left Ventricular Filling Pressure: Product of lnBNP and E/a Ratio.

Oikawa M, Kobayashi A, Wada K, Sato T, Suzuki S, Yoshihisa A, Nakazato K, Suzuki H, Saitoh SI, Ishida T, Takeishi Y.
Journal of cardiac failure.J Card Fail.2017 Oct 12. pii: S1071-9164(17)31231-9. doi: 10.1016/j.cardfail.2017.10.008. [Epub ahead of print]
BACKGROUND: Several echocardiographic parameters are currently being employed to evaluate left ventricular (LV) filling pressure. However, these parameters are not always consistent in the clinical setting. We aimed to determine a novel parameter by multiplying log B-type natriuretic peptide (lnBNP)
PMID 29031870

Right Ventricular Dysfunction in Acute Myocardial Infarction Complicated by Cardiogenic Shock: a Hemodynamic Analysis of the SHould We Emergently Revascularize Occluded Coronaries for Cardiogenic shocK (SHOCK) Trial and Registry.

Lala A1, Guo Y2, Xu J3, Esposito M4, Morine K4, Karas R4, Katz SD2, Hochman JS2, Burkhoff D5, Kapur NK6.
Journal of cardiac failure.J Card Fail.2017 Oct 11. pii: S1071-9164(17)31232-0. doi: 10.1016/j.cardfail.2017.10.009. [Epub ahead of print]
PMID 29032225

Extent of jugular venous distension and lower extremity edema are the best tools from history and physical examination to identify heart failure exacerbation.

Omar HR1, Guglin M2.
Herz.Herz.2017 Oct 9. doi: 10.1007/s00059-017-4623-9. [Epub ahead of print]
PMID 28993841

Japanese Journal

Acute Hemodynamic Effects of Adaptive Servo-Ventilation in Patients With Heart Failure

Yamada Shiro,Sakakibara Mamoru,Yokota Takashi,Kamiya Kiwamu,Asakawa Naoya,Iwano Hiroyuki,Yamada Satoshi,Oba Koji,Tsutsui Hiroyuki
Circulation Journal 77(5), 1214-1220, 2013
… In the univariate analysis, pulmonary capillary wedge pressure (PCWP), mitral regurgitation (MR)/left atrial (LA) area, E/A, E/e', and the sphericity index defined by the ratio between the short-axis and long-axis dimensions of the left ventricle significantly correlated with % change of SVI from baseline during ASV. … PCWP and MR/LA area were independent predictors by multivariate analysis. … 44%) categorized by an increase in SVI showed significantly higher PCWP, MR, and sphericity index. …
NAID 130003361623

Combination Evaluation of Preoperative Risk Indices Predicts Requirement of Biventricular Assist Device

SHIGA Taro,KINUGAWA Koichiro,IMAMURA Teruhiko,KATO Naoko,ENDO Miyoko,INABA Toshiro,MAKI Hisataka,HATANO Masaru,YAO Atsushi,NISHIMURA Takashi,HIRATA Yasunobu,KYO Shunei,ONO Minoru,NAGAI Ryozo
Circulation journal : official journal of the Japanese Circulation Society 76(12), 2785-2791, 2012-11-25
… Preoperative central venous pressure (CVP)/pulmonary capillary wedge pressure (PCWP) ratio ≥0.5 (OR, 13.09; … A new scoring system for predicting BiVAD requirement was created from the combination of CVP/PCWP ratio (≥0.5), body surface area (≤1.4m2), preoperative continuous hemodiafiltration use, B-type natriuretic peptide (≥1,200pg/ml) and LVDd (≤62mm), and this had a significantly larger area under the curve (0.909; …
NAID 10031126049

Low-Dose β-Blocker in Combination With Milrinone Safely Improves Cardiac Function and Eliminates Pulsus Alternans in Patients With Acute Decompensated Heart Failure

KOBAYASHI Shigeki,SUSA Takehisa,TANAKA Takeo,MURAKAMI Wakako,FUKUTA Seiko,OKUDA Shinichi,DOI Masahiro,WADA Yasuaki,NAO Tomoko,YAMADA Jutaro,OKAMURA Takayuki,YANO Masafumi,MATSUZAKI Masunori
Circulation journal : official journal of the Japanese Circulation Society 76(7), 1646-1653, 2012-06-25
… pulmonary capillary wedge pressure [PCWP], 26±8mmHg) were enrolled in this study. … Low-dose landiolol (1.5μg·kg-1·min-1) significantly reduced HR by 11% without changing blood pressure (BP) and CI, whereas higher doses (≥3.0μg·kg-1·min-1) tended to decrease BP and CI while increasing PCWP and systemic vascular resistance. …
NAID 10030503344

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