Pulmonary artery occlusion pressure: Clinical physiology, measurement, and interpretation

Bedside measurement of the pulmonary artery occlusion pressure (wedge, P(w)) has become routine in the practice of critical care. Although P(w) is a potentially useful index of left ventricular filling pressure and pulmonary vascular congestion, an invalid or misinterpreted value can prompt inappropriate clinical decisions. To avoid error P(w) must be measured precisely and interpreted carefully, with consideration given to disordered cardiopulmonary mechanics and to the objectives of therapy. This review focuses on the clinical physiologic aspects of the wedge pressure determination, the technical principles of measurement, and the practical application of the information P(w) provides.