What is the role of respiratory cycle in pulmonary artery catheterization (PAC)?

Updated: Dec 22, 2017
  • Author: Bojan Paunovic, MD; Chief Editor: Karlheinz Peter, MD, PhD  more...
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Answer

The final critical concept in PCWP interpretation is the effect of the respiratory cycle on PCWP measurements. The timing of PCWP measurement is critical because intrathoracic pressures can vary widely with inspiration and expiration and are transmitted to the pulmonary vasculature. During spontaneous inspiration, the intrathoracic pressures decrease (more negative); during expiration, intrathoracic pressures increase (more positive). Positive pressure ventilation (eg, in an intubated patient) reverses this situation. To minimize the effect of the respiratory cycle on intrathoracic pressures, measurements are obtained at end-expiration, when intrathoracic pressure is closest to zero.

In patients with severe respiratory distress, end-expiration can be difficult to determine. In these situations, sedation, or even paralysis, may be necessary to remove the transmission of respiratory efforts to the pressure tracings.


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