tailieunhanh - Critical Care Obstetrics part 24

Critical Care Obstetrics part 24 provides expert clinical guidance throughout on how you can maximize the chances of your patient and her baby surviving trauma. In this stimulating text, internationally recognized experts guide you through the most challenging situations you as an obstetrician are likely to face, enabling you to skillfully:Recognize conditions early-on which might prove life threatening, Implement immediate life-saving treatments in emergency situations, Maximize the survival prospects of both the mother and her fetus | Pulmonary Artery Catheterization their disease and initiate appropriate therapy. Invasive techniques however remain the mainstay of long-term management of complex critically ill obstetric patients. One area of non-invasive assessment warrents special mention. In non-pregnant patients echocardiographic assessment of pulmonary artery pressures are commonly accepted and generally valid. In the past three decades clinicians with extensive experience in the management of pregnant women with pulmonary hypertension have commonly noted significant discrepancies between non-invasive assessment of pulmonary artery pressures and actual pressures measured directly with right heart catheterization. In 2001 this observation was validated by Penny et al. who found that pulmonary artery pressures were commonly overestimated in pregnant women with suspected pulmonary hypertension 72 . Based upon this data and many years of clinical experience we recommend that any pregnant woman with elevated pulmonary artery pressures by echocardiogram have this diagnosis confirmed by invasive right heart catheterization before counseling and critical clinical decisions are initiated. References 1 Swan JHC Ganz W Forrester J et al. Catheterization of the heart in man with use of a flow-directed balloon-tipped catheter. N Engl J Med 1970 283 447-451. 2 Clark SL Horenstein JM Phelan JP et al. Experience with the pulmonary artery catheter in obstetrics and gynecology. Am J Obstet Gynecol 1985 152 374-378. 3 Clark SL Greenspoon JS Aldahl D Phelan JP. Severe preeclampsia with persistent oliguria management of hemodynamic subsets. Am J Obstet Gynecol 1986 154 3 490-494. 4 Clark SL Cotton DB. Clinical opinion clinical indications for pulmonary artery catheterization in the patient with severe preeclampsia. Am J Obstet Gynecol 1988 158 453-458. 5 European Society of Intensive Care Medicine. Expert panel the use of the pulmonary artery catheter. Intensive Care Med 1991 17 I-VIII. 6 Clark SL Phelan JP .