Pulmonary wedge pressure
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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 |
| diastolic | 3–8 | |
| Pulmonary artery pressure | systolic | 15–30 |
| diastolic | 4–12 | |
| Pulmonary vein/ Pulmonary capillary wedge pressure |
2–15 | |
| Left ventricular pressure | systolic | 100–140 |
| 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
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- ↑ Lua error in package.lua at line 80: module 'strict' not found.
- ↑ Table 30-1 in: Lua error in package.lua at line 80: module 'strict' not found.
- ↑ Lua error in package.lua at line 80: module 'strict' not found.
- ↑ Lua error in package.lua at line 80: module 'strict' not found.
- ↑ Harrison's Principles of Internal Medicine. 14th edition. Chapter 38, page 243.
- ↑ Lua error in package.lua at line 80: module 'strict' not found.
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)
