central venous and/or pulmonary occlusion pressure in a hemorrhagic shock
TRANSCRIPT
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CENTRAL VENOUS AND/OR
PULMONARY OCCLUSION
PRESSURE IN A
HEMORRHAGIC SHOCK, IS IT
LOW, NORMAL, OR HIGH?
Abdulrhman M AljoherS 62 (8)
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Outline
Introduction
Concepts
Central venous pressure (low, normal, high)?
Pulmonary occlusion pressure (low, normal, high)?
Conclusion
References
1
2
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5
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•Central venous pressure
•Pulmonary occlusion pressure
Introduction
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Central venous pressure
• describes the pressure in the thoracic vena cava near the right atrium (therefore CVP and right atrial pressure are essentially the same).
• CVP is a major determinant of the filling pressure and therefore the preload of the right ventricle, which regulates stroke volume through the Frank-Starling mechanism.
"central venous pressure" (CVP)
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Central venous pressure
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Pulmonary occlusion
pressure
• Also known as pulmonary capillary wedge pressure or PCWP
• provides an indirect estimate of left atrial pressure (LAP). Although left ventricular pressure can be directly measured by placing a catheter within the left ventricle
Pulmonary occlusion pressure
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•Focused on the CVP
Concepts
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Central venous pressure
Examination of internal jugular venous pulsations has generally been preferred for estimating central venous pressure as
well as right-sided hemodynamics.
ΔCVP = ΔV / Cv
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Reduction CVP
leading to a decrease in venous pressure.
The reduction in the vascular volume observed with hypovolemia occurs primarily
in the venous circulation(which normally contains 70 percent of the
blood volume),
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Factor increasing the CVP
Decreased cardiac output
Increased blood volume
Venous constriction
Changing from standing
to supine body posture
Arterial dilation
Forced expiration
(e.g., Valsalva)
Muscle contraction (abdominal and limb)
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So, what would happen to the CVP when the
volume decrease?
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The CVP
will
decrease
s
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How about the PWCP?!
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Yeah!
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Conclusion
Central venous pressure estimates the
right atrial pressure
Pulmonary capillary wedge pressure
estimates the left atrial pressure.
The values reflect end-diastolic volume, or
preload, of the right and left ventricles,
respectively.
Central venous pressure and pulmonary
capillary wedge pressure both would have
been decreased because of the loss of
blood volume from the venous side of the
circulation.
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Conclusion
CVP
• measured in the vena cava.
• Its value is related to the volume of blood in the veins and is approximately equal to the right atrial pressure.
PCWP
• measured by advancing a catheter through the pulmonary artery until it “wedges” in the artery’s smallest branch.
• At that point, the catheter senses pulmonary capillary pressure, which is nearly equal to the left atrial pressure.
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References
http://www.uptodate.com/contents/pulmon
ary-artery-catheterization-interpretation-of-
tracings?source=search_result&search=Pu
lmonary+Artery+Wedge+Pressure+and+We
dging&selectedTitle=1~150#H14
Physiology: Cases and Problems
http://cvphysiology.com/Heart%20Failure/H
F008.htm
http://cvphysiology.com/Blood%20Pressur
e/BP020.htm
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Be always enlightened!
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Be always shiny!
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Thank You