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Diagram of a pulmonary artery catheter in position. The pulmonary wedge pressure (PWP) (also called pulmonary arterial wedge pressure (PAWP), pulmonary capillary wedge pressure (PCWP), pulmonary artery occlusion pressure (PAOP), or cross-sectional pressure) is the pressure measured by wedging a pulmonary artery catheter with an inflated balloon into a small pulmonary arterial branch. [1]
A pulmonary artery wedge pressure being less than 15 mmHg (also measured by right heart catheterization) excludes post-capillary bed (in the veins distal to the capillary bed) pulmonary hypertension. Pulmonary arterial hypertension is a subgroup of pulmonary hypertension and is categorized as World Health Organization as group 1. [ 3 ]
Pulmonary hypertension is defined as a mean PAP of at least 20 mm Hg (3300 Pa) at rest, and PAH is defined as precapillary pulmonary hypertension (i.e. mean PAP ≥ 20 mm Hg with pulmonary arterial occlusion pressure [PAOP] ≤ 15 mm Hg and pulmonary vascular resistance [PVR] > 3 Wood Units). [58]
Of the forces that explain fluid movement, only the pulmonary wedge pressure is obtainable via pulmonary artery catheterization. [10] Due to the complication rate associated with pulmonary artery catheterization, other imaging modalities and diagnostic methods have become more popular. [11]
The standard pulmonary artery catheter has two lumens (Swan-Ganz) and is equipped with an inflatable balloon at the tip, which facilitates its placement into the pulmonary artery through the flow of blood. The balloon, when inflated, causes the catheter to "wedge" in a small pulmonary blood vessel.
The pulmonary artery pressure (PA pressure) is a measure of the blood pressure found in the main pulmonary artery. This is measured by inserting a catheter into the main pulmonary artery. [13]: 190–191 The mean pressure is typically 9–18 mmHg, [14] and the wedge pressure measured in the left atrium may be 6–12 mmHg.
Local venous pressure falls to -5 at the apexes and rises to +15 mmHg at the bases, again for the erect lung. Pulmonary blood pressure is typically in the range 25–10 mmHg with a mean pressure of 15 mmHg. Regional arterial blood pressure is typically in the range 5 mmHg near the apex of the lung to 25 mmHg at the base.
High cardiac index and pulmonary capillary wedge pressures, however, may lead to false positives by this standard. By one institution's evaluation, the correlation between estimated systolic PAP and directly measured PAP was poor, 0.49. [24] For these reasons, right heart catheterization is needed to confirm the diagnosis. [citation needed]