Relationship between central venous pressure and pulmonary capillary wedge pressure in severely...
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Volume 165 Number 2 tum patients who carry the group B streptococcus bac- teria. David E. Green, MD, G. Wright Bates, MSIV, and Stephen P. Emery, MSIV Department of Obstetrics and Gynecology, University of Alabama School of Medicine. Huntsville Program, 109 Governors Dr. SW, Huntsville, AL 35801 Response declined Relationship between central venous pressure and pulmonary capillary wedge pressure in severely toxemic patients To the Editors: In treating patients with severe toxemia Fliegner' emphasized fluid volume expansion to raise central venous pressure to a range between 5 and 10 cm H 2 0. However, Clark 2 has observed an inconsistent relationship between central venous pressure and left- side heart pressures as estimated by pulmonary capil- lary wedge pressure , suggesting that it is dangerous and simplistic to rely on central venous pressure alone for fluid management in patients with severe pre- eclampsia. In our intensive care unit we took 623 central venous pressure and pulmonary capillary wedge pressure mea- surements with a pulmonary artery catheter in 60 pa- tients with severe preeclampsia. Of these measurements 123 were taken without treatment or fluid management (basal), and 500 were taken after hypotensor treatment (clonidine hydrochloride or diazoxide). The correlation values are shown in Table I. Our data show acceptable values for both correlation and linear regression between central venous pressure and pulmonary capillary wedge pressure under both conditions. However, the variability of correlation val- ues within a single patient is enormous: for a central venous pressure of 4 mm Hg, the corresponding pul- monary capillary wedge pressure values were between -1.7 and 17.5 mm Hg. This tends to support Clark's assessment that the exclusive use of central venous pres- sure for fluid management in these patients is inade- quate and potentially dangerous, especially if there ap- pear to be oncotic pressure alterations with resulting pulmonary edema. ' Our results suggest that the cor- relation between central venous pressure and pulmo- nary capillary wedge pressure is valid only when con- sidered in a group of patients because of the variability of individual values. Ramon Tellez, MD, and Roberto Curiel, MD Unidad de Cuidados Intensivos, Hospital Central Portuguesa, Acartgua-Araure, Estado Portuguesa, Aptdo. Postal 39 Acarigua 3301, Vene.uela Letters 487 REFERENCES 1. Fliegner JR. Correction of hypovolemia and central venous monitoring in the management of severe pre- eclampSia and eclampsia. AM J OBSTET GVNECOl 1987;) 56: 1041. 2. Clark SL. Reliance on central venous pressure with regard to fluid management in preeclampsia deemed dangerous. AM] OBSTET GYNECOL 1990;162:598. 3. L!ndhei?,er MD, Katz AI. Preeclampsia: pathophysiology, diagnOSIs, and management. Am Rev Med 1989;40:233. Prolonged exposure to wood preservatives induces endocrine and Immunologic disorders In women To the Editors: The toxic effects of polychlorinated or- ganic. compounds are associated with spontaneous abortlons, fetal malformations, growth retardation stillbirths, thymic degeneration, reduced fertility, and changes in the menstrual cycle. 1 - 9 During the postwar economic boom, wood coated with organic compounds containing preservatives was used for ceilings and wall panels of Carpets and leather upholstery impregnated wlth moth repellants contained the same organic com- pounds. Pentachlorophenol and the 'V-isomer of hexa- chlorocyclohexane (lindane) were thus brought into homes during modernization. The steady emission of these vapors into today's highly insulated, draft- proofed homes raises the specter of prolonged expo- sure .because these toxins can be incorporated by in- halatIOn, oral uptake, and skin contact. Pentachloro- phenol and lindane are easily measured by capillary and mass spectroscopy. We deter- mmed whether these toxins are present in the blood of women referred for endocrinologic evaluation. We examined 90 women with histories of habitual abortion (n = 30), unexplained infertility (n = 20), menstrual disorders (n = 20) , or climacteric symptoms (n = 20). In 22 women elevated pentachlorophenol (>25 or lindane (> 100 ng/L) levels, or both , were found. This group included 8 infertile women, 6 with histories of repeated abortions; 8 women with menstrual disorders ; and 6 women with climacteric symptoms and menstrual irregularities complicated by depression. The duration of exposure was shortest in i,:fertility (mean = 4.6 years), followed by menstrual dlsorders (mean = 6 years) and climacteric symptoms (mean = 10 years). Pentachlorophenol and lindane were highest in women with infertility (pentachloro- phenol mean = 73 lindane mean = 250 ng/L), lower in those with menstrual dysfunction (penta- chlorophenol mean = 42 lindane mean = 210 ng/L), and lowest in patients with climacteric symp- Table I. Correlation between central venous pressure and pulmonary capillary wedge pressure Conditions I n I CVP (mm Hg) I PCWP (mm Hg) I r Basal Posttreatment TOTAL 123 500 623 4.0:±: 3.0 4.1 :±: 3.4 4.1 :±: 3.3 7.9 ± 4.5 7.9 ± 4.6 7.9 ± 4.6 CVP, Central venous pressure; PCWP , pulmonary capillary wedge pressure. 0.651 0.647 0.646 p 0.001 0.001 0 .001
Transcript of Relationship between central venous pressure and pulmonary capillary wedge pressure in severely...
Volume 165 Number 2
tum patients who carry the group B streptococcus bacteria.
David E. Green, MD, G. Wright Bates, MSIV, and Stephen P. Emery, MSIV
Department of Obstetrics and Gynecology, University of Alabama School of Medicine. Huntsville Program, 109 Governors Dr. SW, Huntsville, AL 35801
Response declined
Relationship between central venous pressure and pulmonary capillary wedge pressure in severely toxemic patients To the Editors: In treating patients with severe toxemia Fliegner' emphasized fluid volume expansion to raise central venous pressure to a range between 5 and 10 cm H 20. However, Clark2 has observed an inconsistent relationship between central venous pressure and leftside heart pressures as estimated by pulmonary capillary wedge pressure, suggesting that it is dangerous and simplistic to rely on central venous pressure alone for fluid management in patients with severe preeclampsia.
In our intensive care unit we took 623 central venous pressure and pulmonary capillary wedge pressure measurements with a pulmonary artery catheter in 60 patients with severe preeclampsia. Of these measurements 123 were taken without treatment or fluid management (basal), and 500 were taken after hypotensor treatment (clonidine hydrochloride or diazoxide). The correlation values are shown in Table I.
Our data show acceptable values for both correlation and linear regression between central venous pressure and pulmonary capillary wedge pressure under both conditions. However, the variability of correlation values within a single patient is enormous: for a central venous pressure of 4 mm Hg, the corresponding pulmonary capillary wedge pressure values were between -1.7 and 17.5 mm Hg. This tends to support Clark's assessment that the exclusive use of central venous pressure for fluid management in these patients is inadequate and potentially dangerous, especially if there appear to be oncotic pressure alterations with resulting pulmonary edema.' Our results suggest that the correlation between central venous pressure and pulmonary capillary wedge pressure is valid only when considered in a group of patients because of the variability of individual values.
Ramon Tellez, MD, and Roberto Curiel, MD Unidad de Cuidados Intensivos, Hospital Central Portuguesa, Acartgua-Araure, Estado Portuguesa, Aptdo. Postal 39 Acarigua 3301, Vene.uela
Letters 487
REFERENCES
1. Fliegner JR. Correction of hypovolemia and central venous pressur~ monitoring in the management of severe preeclampSia and eclampsia. AM J OBSTET GVNECOl 1987; ) 56: 1041.
2. Clark SL. Reliance on central venous pressure with regard to fluid management in preeclampsia deemed dangerous. AM] OBSTET GYNECOL 1990;162:598.
3. L!ndhei?,er MD, Katz AI. Preeclampsia: pathophysiology, diagnOSIs, and management. Am Rev Med 1989;40:233.
Prolonged exposure to wood preservatives induces endocrine and Immunologic disorders In women To the Editors: The toxic effects of polychlorinated organic. compounds are associated with spontaneous abortlons, fetal malformations, growth retardation stillbirths, thymic degeneration, reduced fertility, and changes in the menstrual cycle. 1
-9
During the postwar economic boom, wood coated with pol~chlorinated organic compounds containing preservatives was used for ceilings and wall panels of h~mes. Carpets and leather upholstery impregnated wlth moth repellants contained the same organic compounds. Pentachlorophenol and the 'V-isomer of hexachlorocyclohexane (lindane) were thus brought into homes during modernization. The steady emission of these vapors into today's highly insulated, draftproofed homes raises the specter of prolonged exposure .because these toxins can be incorporated by inhalatIOn, oral uptake, and skin contact. Pentachlorophenol and lindane are easily measured by capillary c~romatography and mass spectroscopy. We determmed whether these toxins are present in the blood of women referred for endocrinologic evaluation.
We examined 90 women with histories of habitual abortion (n = 30), unexplained infertility (n = 20), menstrual disorders (n = 20) , or climacteric symptoms (n = 20). In 22 women elevated pentachlorophenol (>25 ~g/L) or lindane (> 100 ng/L) levels, or both, were found. This group included 8 infertile women, 6 with histories of repeated abortions; 8 women with menstrual disorders; and 6 women with climacteric symptoms and menstrual irregularities complicated by depression. The duration of exposure was shortest in i,:fertility (mean = 4.6 years), followed by menstrual dlsorders (mean = 6 years) and climacteric symptoms (mean = 10 years). Pentachlorophenol and lindane were highest in women with infertility (pentachlorophenol mean = 73 ~g/ L, lindane mean = 250 ng/L), lower in those with menstrual dysfunction (pentachlorophenol mean = 42 ~g/L, lindane mean = 210 ng/L), and lowest in patients with climacteric symp-
Table I. Correlation between central venous pressure and pulmonary capillary wedge pressure
Conditions I n I CVP (mm Hg) I PCWP (mm Hg) I r
Basal Posttreatment TOTAL
123 500 623
4.0:±: 3.0 4.1 :±: 3.4 4.1 :±: 3.3
7.9 ± 4.5 7.9 ± 4.6 7.9 ± 4.6
CVP, Central venous pressure; PCWP, pulmonary capillary wedge pressure.
0.651 0.647 0.646
p
0.001 0.001 0.001
