Distal Migration of the Pulmonary Artery Catheter During Cardiac Surgery With Cardiopulmonary Bypass Observed Using Transesophageal Echocardiography: A Prospective Observational Study.

IF 2.1 4区 医学 Q2 ANESTHESIOLOGY
Nobuko Ohashi, Hidekazu Imai, Mayuko Inaba, Tsurara Wada, Mirai Momose, Tomoaki Kamoda, Tatsuya Abe, Teppei Yamada, Rintaro Hoshino, Keiichiro Matsuda, Yutaka Seino, Keiko Bamba, Tomohiro Yamamoto, Hiroshi Baba
{"title":"Distal Migration of the Pulmonary Artery Catheter During Cardiac Surgery With Cardiopulmonary Bypass Observed Using Transesophageal Echocardiography: A Prospective Observational Study.","authors":"Nobuko Ohashi, Hidekazu Imai, Mayuko Inaba, Tsurara Wada, Mirai Momose, Tomoaki Kamoda, Tatsuya Abe, Teppei Yamada, Rintaro Hoshino, Keiichiro Matsuda, Yutaka Seino, Keiko Bamba, Tomohiro Yamamoto, Hiroshi Baba","doi":"10.1053/j.jvca.2025.08.047","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>To investigate the extent of pulmonary artery catheter (PAC) tip migration during cardiac surgery using cardiopulmonary bypass (CPB), as visualized by transesophageal echocardiography (TEE).</p><p><strong>Design: </strong>A prospective, observational study.</p><p><strong>Setting: </strong>A single tertiary university hospital operating room.</p><p><strong>Participants: </strong>A total of 146 adult patients undergoing elective cardiac surgery with cardiac arrest and CPB who received PAC placement.</p><p><strong>Interventions: </strong>PACs were inserted under TEE guidance, positioning the tip at the 1 o'clock position in the proximal right pulmonary artery. TEE was used throughout surgery to monitor PAC tip position, particularly before and after CPB.</p><p><strong>Measurements and main results: </strong>The primary outcome was the distance of PAC tip migration during surgery. The median migration distance from pre to post CPB was 3.0 cm (interquartile range, 3.0-4.0 cm), prompting catheter withdrawal in these cases. Patients requiring >3 cm withdrawal had significantly longer catheter insertion lengths and higher mean pulmonary artery pressure and central venous pressure before CPB. Identified cutoff values were 46.5 cm for catheter length, 22.5 mmHg for mean pulmonary artery pressure, and 9.5 mmHg for central venous pressure.</p><p><strong>Conclusions: </strong>TEE-enabled direct visualization showed that PAC tips commonly migrate approximately 3 cm during cardiac surgery with CPB, necessitating withdrawal to prevent distal complications. Patients with longer catheter insertions and higher pulmonary artery pressure and central venous pressure may require more extensive withdrawal. TEE monitoring is a valuable tool for guiding PAC management during cardiac surgery.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.1000,"publicationDate":"2025-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of cardiothoracic and vascular anesthesia","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1053/j.jvca.2025.08.047","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ANESTHESIOLOGY","Score":null,"Total":0}
引用次数: 0

Abstract

Objectives: To investigate the extent of pulmonary artery catheter (PAC) tip migration during cardiac surgery using cardiopulmonary bypass (CPB), as visualized by transesophageal echocardiography (TEE).

Design: A prospective, observational study.

Setting: A single tertiary university hospital operating room.

Participants: A total of 146 adult patients undergoing elective cardiac surgery with cardiac arrest and CPB who received PAC placement.

Interventions: PACs were inserted under TEE guidance, positioning the tip at the 1 o'clock position in the proximal right pulmonary artery. TEE was used throughout surgery to monitor PAC tip position, particularly before and after CPB.

Measurements and main results: The primary outcome was the distance of PAC tip migration during surgery. The median migration distance from pre to post CPB was 3.0 cm (interquartile range, 3.0-4.0 cm), prompting catheter withdrawal in these cases. Patients requiring >3 cm withdrawal had significantly longer catheter insertion lengths and higher mean pulmonary artery pressure and central venous pressure before CPB. Identified cutoff values were 46.5 cm for catheter length, 22.5 mmHg for mean pulmonary artery pressure, and 9.5 mmHg for central venous pressure.

Conclusions: TEE-enabled direct visualization showed that PAC tips commonly migrate approximately 3 cm during cardiac surgery with CPB, necessitating withdrawal to prevent distal complications. Patients with longer catheter insertions and higher pulmonary artery pressure and central venous pressure may require more extensive withdrawal. TEE monitoring is a valuable tool for guiding PAC management during cardiac surgery.

经食管超声心动图观察心脏手术伴体外循环时肺动脉导管远端移位:一项前瞻性观察研究。
目的:探讨经食管超声心动图(TEE)显示的体外循环(CPB)心脏手术中肺动脉导管(PAC)尖端偏移的程度。设计:前瞻性观察性研究。环境:单一的三级大学医院手术室。参与者:共有146名接受PAC放置的心脏骤停和CPB选择性心脏手术的成年患者。干预措施:在TEE引导下插入pac,将尖端定位在右肺近端动脉1点钟位置。TEE在整个手术过程中用于监测PAC尖端位置,特别是在CPB前后。测量和主要结果:主要结果是术中PAC尖端移动的距离。CPB前后的中位移动距离为3.0 cm(四分位数范围为3.0-4.0 cm),促使这些病例拔管。需要撤置bbb30 cm的患者在CPB前导管插入长度明显延长,平均肺动脉压和中心静脉压较高。确定的截止值为导管长度46.5 cm,平均肺动脉压22.5 mmHg,中心静脉压9.5 mmHg。结论:tee支持的直接可视化显示,在CPB心脏手术中,PAC尖端通常移动约3cm,需要停药以防止远端并发症。导管插入时间较长、肺动脉压和中心静脉压较高的患者可能需要更广泛的停药。TEE监测是指导心脏手术期间PAC管理的重要工具。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
CiteScore
4.80
自引率
17.90%
发文量
606
审稿时长
37 days
期刊介绍: The Journal of Cardiothoracic and Vascular Anesthesia is primarily aimed at anesthesiologists who deal with patients undergoing cardiac, thoracic or vascular surgical procedures. JCVA features a multidisciplinary approach, with contributions from cardiac, vascular and thoracic surgeons, cardiologists, and other related specialists. Emphasis is placed on rapid publication of clinically relevant material.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:604180095
Book学术官方微信