Pulmonary artery diastolic-wedge gradients as a predictor of mortality in critically ill surgical patients

Christopher J. Dente*, James Tyburski, Christopher Steffes, Aaron Rabinovich, Lisa Flynn, Julie Collinge, Robert F. Wilson

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Introduction: There is ongoing controversy as to the efficacy of pulmonary artery catheter monitoring in critically ill patients. However, pulmonary artery diastolic pressure (PAD) to pulmonary capillary wedge pressure (PCWP) gradients (DWG) of six or greater have been associated with an increased mortality in previous studies. Methods: In the current study, PA Catheter measurements from 125 critically ill surgical patients in an urban teaching institution were recorded prospectively. Each data set included the recorded PCWP, the pulmonary vascular resistance (PVR), and the pulmonary pressures: systolic pressure (SPAP), PAD and mean pulmonary pressure (MPAP). Results: Overall mortality was 28%(35/125). Of the 899 data sets recorded, 90 (10%) recorded the PCWP as higher than the PAD, indicating the data are in error. This rate was significantly less than in a previous report from this institution where 18.5% (356/1922) of data sets were in error using this simple criterion (p<.001). Eliminating these data sets left 809 sets in 125 patients. The factors, relating to pulmonary hypertension, that predicted mortality and their corresponding p values are listed in the table below. Conclusions: In the surgical critical care patient, pulmonary hypertension continues to signify an increased risk for mortality. The diastolic-wedge gradient is an easy to use number that not only indicates the degree of hypertension, but also can be used to assess the accuracy of the data. Improvements in critical care have led to a slight increase in the gradient associated with higher mortality (from six to eight). A significant decrease in the number of negative gradients, indicating an increased awareness of inaccurate data, may also have played a role. FACTOR DWG ≥ 8 SPAP > 35 PAD > 15 MPAP > 25 PVR > 200 MORTALITY PULM HTN 35%(28/81) 35%(29/82) 32%(33/104) 37%(27/73) 38%(18/47) MORTALITY NORMAL 16%(7/44) 14%(6/43) 9.5%(2/21) 15%(8/52) 22%(17/78) p VALUE .0222 .0084 .0244 .0066 .0486.

Original languageEnglish
Pages (from-to)A52
JournalCritical Care Medicine
Issue number12 SUPPL.
StatePublished - 1999
Externally publishedYes


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