Objective To accurately measure the end-expiratory pulmonary artery wedge pressure (PAWP) with the expiration holding function on the ventilator and the pulmonary artery wedge pressure review software on the monitor. pressure display measurement group (P<0.001). Additionally, the EH group was associated with lower medical costs. Conclusion The expiration holding approach measured the PAWP more accurately, more quickly, and with reduced costs in comparison to the airway pressure display approach. Keywords: expiration holding, pulmonary artery wedge pressure, eePAWP, Begacestat mechanical ventilation, pulmonary artery catheter Introduction Pulmonary artery wedge pressure (PAWP) reading is important in intensive care. At the end of expiration, the PAWP accurately reflects central vessel pressures.1 The measurement of end-expiratory PAWP (eePAWP) Rabbit Polyclonal to HTR4. has, therefore, attracted much attention, and various approaches have been developed.2,3 The Fluids and Catheters Treatment Trial4 (FACTT) in 2005 showed that the airway pressure display approach led to good results for eePAWP measurement; however, the procedure was complicated, leading to low compliance for the user. The expiration holding approach that we recently developed combines the expiration holding function on the ventilator and the PAWP review software on the monitor for eePAWP measurements, showing high accuracy.5 With the expiration holding function, the ventilator maintains a breathing-out state for 15 seconds in order to measure the maximum inspiratory negative pressure of the patient, as well as to guide the withdrawal of the ventilator. With this function, positive ventilation was maintained at the breathing-out phase and, therefore, the effect of positive pressure ventilation on blood pressure was eliminated. In the case of spontaneous breathing, the program function was started at the end of spontaneous breathing, and the effect of spontaneous breathing on blood pressure was eliminated as well. This would lead to a steady blood pressure waveform when positive pressure ventilation and spontaneous breathing both occurred at the end of expiration. The PAWP review software is available in most monitors to measure selected waveforms accurately. In the present study, we demonstrated that combing the expiration holding function of a ventilator and the PAWP review software could lead to the accurate, convenient, and user-friendly Begacestat measurement of eePAWP. Materials and methods Preparation The experimental group was established as described in the FACTT trial.4 The detailed PAWP measurement procedure was established, and systemic training of all of the staff members was performed. One person was in charge of the waveform strips for PAWP-steady graphics and blood vessel/airway pressure waveforms. For each measurement, the waveform was first read by one experienced doctor, and then it was blindly and separately read by six additional experts (a total of seven results). All experts received standard training as above that was specific in Pulmonary Artery Catheter Education Project level 2. The experts have worked in this area for more than 5 years. Clinical data The 12 patients who underwent pulmonary artery catheter (PAC) and mechanical ventilation in our intensive care unit were prospectively recruited from August 2009 to August 2012. All measurements were divided into <8 mmHg or 8 mmHg according to respiratory variability (RV), and they were then subdivided into either an airway pressure display measurement (AM) group or an expiration holding (EH) group for comparisons. All measurements were composed of positive Begacestat pressure ventilation mixed with spontaneous breathing. The mode was dual-level positive pressure ventilation plus assisted spontaneous breathing. The study was approved by the Ethics Committee on the Medical Research on Human Subjects of the Fifth Central Hospital of Tianjin. Informed written consent was obtained from all Begacestat of the subjects. Monitoring The patients were placed with a 7F PAC (Edwards Life-sciences Corporation, Irvine, CA, USA) in the right internal jugular vein, and subsequently connected to a GE Dash 4000 monitor (GE Healthcare Bio-Sciences Corp, Piscataway, NJ, USA). The catheter tip was placed into the pulmonary WEST III region with computed tomography examination. The pressure sensor was positioned at the same level as the axillary line at the fourth intercostal space. Before each measurement, the mechanical zero and electric zero positions were adjusted. The airway pressure display approach was conducted as described previously,4 with sample results shown in Figure 1. The end of expiration was identified by drawing a vertical line 200 ms before the initial positive or bad pulmonary artery wedge deflection of each breath. The time when the final data were captured (a total of seven results) was recorded as Begacestat T1. Number 1 The strip from your FACTT airway pressure display approach..