RT Journal Article
SR Electronic
T1 Measuring central pulmonary pressures during exercise in COPD: how to cope with respiratory effects
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP 1316
OP 1325
DO 10.1183/09031936.00016913
VO 43
IS 5
A1 Bart G. Boerrigter
A1 Aaron B. Waxman
A1 Nico Westerhof
A1 Anton Vonk-Noordegraaf
A1 David M. Systrom
YR 2014
UL http://erj.ersjournals.com/content/43/5/1316.abstract
AB Respiratory influences are major confounders when evaluating central haemodynamics during exercise. We studied four different methods to assess mean pulmonary artery pressure (mPAP) and pulmonary capillary wedge pressure (PCWP) in cases of respiratory swings. Central haemodynamics were measured simultaneously with oesophageal pressure during exercise in 30 chronic obstructive pulmonary disease (COPD) patients. mPAP and PCWP were assessed at the end of expiration, averaged over the respiratory cycle and corrected for the right atrial pressure (RAP) waveform estimated intrathoracic pressure, and compared with the transmural pressures. Bland–Altman analyses showed the best agreement of mPAP averaged over the respiratory cycle (bias (limits of agreement) 2.5 (-6.0–11.8) mmHg) and when corrected with the nadir of RAP (-3.6 (-11.2–3.9) mmHg). Measuring mPAP at the end of expiration (10.3 (0.5–20.3) mmHg) and mPAP corrected for the RAP swing (-9.3 (-19.8–2.1) mmHg) resulted in lower levels of agreement. The respiratory swings in mPAP and PCWP were similar (r2=0.82, slope±se 0.95±0.1). Central haemodynamics measured at the end of expiration leads to an overestimation of intravascular pressures in exercising COPD patients. Good measurement can be acquired even when oesopghageal pressure is omitted, by averaging pressures over the respiratory cycle or using the RAP waveform to correct for intrathoracic pressure. Assessment of the pulmonary gradient is unaffected by respiratory swings. Measurement of intravascular pressures in exercising COPD patients requires correction for intrathoracic pressure http://ow.ly/tVLlg