Uppermost blood levels of the right and left atria in the supine position: implication for measuring central venous pressure and pulmonary artery wedge pressure.

Abstract:

BACKGROUND:To eliminate the influence of hydrostatic pressure, proper transducer positions for central venous pressure and pulmonary artery wedge pressure are at the uppermost blood levels of right atrium (RA) and left atrium (LA). This study was performed to investigate accurate reference levels of central venous pressure and pulmonary artery wedge pressure in the supine position. METHODS:Chest computed tomography images of 96 patients without history of cardiothoracic surgery, heart disease, or cardiothoracic anatomical abnormality were retrospectively reviewed. The anteroposterior (AP) diameter of the thorax and the vertical distances from the skin on the back to the most anterior portion of RA (RA height) and LA (LA height) were measured. Their ratios were abbreviated, respectively, as RA height/AP diameter and LA height/AP diameter. Data are expressed as mean +/- SD (range). RESULTS:There was a significant difference [4.6 +/- 1.0 (1.6-6.4) cm; P < 0.001] between RA and LA heights. AP diameter was positively correlated with RA and LA heights (R = 0.839 and 0.700, respectively; P < 0.001). There was also a significant difference between RA height/AP diameter [0.83 +/- 0.03 (0.71-0.91)] and LA height/AP diameter [0.62 +/- 0.04 (0.52-0.72)] (P < 0.001). CONCLUSION:In the supine position, a central venous pressure transducer should be positioned approximately 4.6 cm higher than a pulmonary artery wedge pressure transducer. The external reference level for central venous pressure seems to be at approximately four fifths of the AP diameter of the thorax from the back, and that for pulmonary artery wedge pressure seems to be at approximately three fifths of the AP diameter.

journal_name

Anesthesiology

journal_title

Anesthesiology

authors

Seo JH,Jung CW,Bahk JH

doi

10.1097/01.anes.0000270720.67307.fa

subject

Has Abstract

pub_date

2007-08-01 00:00:00

pages

260-3

issue

2

eissn

0003-3022

issn

1528-1175

pii

00000542-200708000-00013

journal_volume

107

pub_type

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