دورية أكاديمية
أعرض في EDS

Impact of Esophageal Pressure Measurement on Pulmonary Hypertension Diagnosis in Patients With Obesity.

التفاصيل البيبلوغرافية
العنوان: Impact of Esophageal Pressure Measurement on Pulmonary Hypertension Diagnosis in Patients With Obesity.
المؤلفون: Khirfan G; Department of Pulmonary and Critical Care Medicine, Cleveland Clinic, Cleveland., Melillo CA; Department of Inflammation and Immunity, Cleveland Clinic, Cleveland., Al Abdi S; Department of Internal Medicine, Cleveland Clinic Fairview Hospital, Fairview, OH., Lane JE; Nursing Institute, Cleveland Clinic, Cleveland., Dweik RA; Department of Pulmonary and Critical Care Medicine, Cleveland Clinic, Cleveland., Chatburn RL; Respiratory Institute, Cleveland Clinic, Cleveland., Hatipoğlu U; Department of Pulmonary and Critical Care Medicine, Cleveland Clinic, Cleveland., Tonelli AR; Department of Pulmonary and Critical Care Medicine, Cleveland Clinic, Cleveland. Electronic address: tonella@ccf.org.
المصدر: Chest [Chest] 2022 Sep; Vol. 162 (3), pp. 684-692. Date of Electronic Publication: 2022 Apr 09.
نوع المنشور: Journal Article; Research Support, N.I.H., Extramural
اللغة: English
بيانات الدورية: Publisher: Elsevier Country of Publication: United States NLM ID: 0231335 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1931-3543 (Electronic) Linking ISSN: 00123692 NLM ISO Abbreviation: Chest Subsets: MEDLINE
أسماء مطبوعة: Publication: 2016- : New York : Elsevier
Original Publication: Chicago : American College of Chest Physicians
مواضيع طبية MeSH: Hypertension, Pulmonary*/diagnosis , Hypertension, Pulmonary*/etiology, Aged ; Cardiac Catheterization ; Hemodynamics ; Humans ; Middle Aged ; Obesity/complications ; Prospective Studies ; Pulmonary Wedge Pressure
مستخلص: Background: Elevated intrathoracic pressure could affect pulmonary vascular pressure measurements and influence pulmonary hypertension (PH) diagnosis and classification. Esophageal pressure (P es ) measurement adjusts for the increase in intrathoracic pressure, better reflecting the pulmonary hemodynamics in patients with obesity.
Research Question: In individuals with obesity, what is the impact of adjusting pulmonary hemodynamic determinations for P es on PH diagnosis and classification? Can P es be estimated by positional or respiratory hemodynamic changes?
Study Design and Methods: In this prospective cohort study, we included patients with obesity who underwent right heart catheterization and demonstrated elevated pulmonary artery wedge pressure (PAWP; ≥ 12 mm Hg). After placement of an esophageal balloon, we performed pressure determination using an air-filled transducer connected to a regular hemodynamic monitor. We measured pulmonary pressures changes when sitting and the variations during the respiratory cycle.
Results: We included 53 patients (mean ± SD age, 59 ± 12 years; mean ± SD BMI, 44.4 ± 10.2 kg/m 2 ). Supine end-expiratory pressures revealed a mean pulmonary artery pressure of > 20 mm Hg in all patients and a PAWP of >15 mm Hg in most patients (n = 50). The P es adjustment led to a significant decrease in percentage of patients with postcapillary PH (from 60% to 8%) and combined precapillary and postcapillary PH (from 34% to 11%), at the expense of an increase in percentage of patients with no PH (0% to 23%), isolated precapillary PH (2% to 25%), and undifferentiated PH (4% to 34%).
Interpretation: Adjusting pulmonary hemodynamics for P es in patients with obesity leads to a pronounced reduction in the number of patients who receive a diagnosis of postcapillary PH. Measuring P es should be considered in patients with obesity, particularly those with elevated PAWP.
(Copyright © 2022 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.)
التعليقات: Comment in: Chest. 2022 Sep;162(3):511-513. (PMID: 36088092)
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فهرسة مساهمة: Keywords: esophageal pressure; intrathoracic pressure; obesity; pulmonary hypertension; right heart catheterization
تواريخ الأحداث: Date Created: 20220411 Date Completed: 20220913 Latest Revision: 20230902
رمز التحديث: 20240628
مُعرف محوري في PubMed: PMC9808718
DOI: 10.1016/j.chest.2022.04.002
PMID: 35405108
قاعدة البيانات: MEDLINE
الوصف
تدمد:1931-3543
DOI:10.1016/j.chest.2022.04.002