Bedside assessment of left atrial pressure in critical care: a multifaceted gem

Table 1 Caveats of invasive pulmonary artery catheter measurement of PAOP and correlation with LAP, LVEDP and LVEDV in critical illness

PAOP \(\ne\) LAP \(\ne\) LVEDP	LVEDP \(\ne\) LVEDV
Technical, e.g. calibration, zeroing, damping, digital recording, respiratory variation	Altered LV chamber compliance, e.g. diastolic dysfunction, myocardial ischaemia, LV hypertrophy (chronic HTN, aortic stenosis, hypertrophic cardiomyopathy, cardiac amyloid)
Catheter tip position in non-west zone 3, ‘overwedging’	Increased pleural pressure (PEEP, mechanical ventilation)
Physiological non-west zone 3 (ARDS, hypovolaemia, low CO, high PEEP)	High juxtacardiac pressures (cardiac tamponade, constrictive pericarditis, PEEP)
Valvular disease (Mitral valve stenosis and regurgitation (meanLAP > LVEDP), Aortic regurgitation (meanLAP < LVEDP))	RV pressure/volume overload and leftward septal shift (PE, ARDS, RV infarction)
LA pathology (Atrial myxoma, reduced LA compliance (following ablation procedure, critical illness)
Pulmonary venous obstruction (tumour, mediastinal fibrosis, extensive pulmonary venous thrombosis, pulmonary veno-occlusive disease)

PEEP positive end-expiratory pressure; HTN-systemic hypertension; LV left ventricle; RV right ventricle; PE pulmonary embolism; LA left atrium; ARDS acute respiratory distress syndrome; LVEDP left ventricular end-diastolic pressure; CO cardiac output; PAOP pulmonary artery occlusion pressure; LAP left atrial pressure; LVEDV left ventricular end-diastolic volume

ISSN: 1364-8535