{"title":"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。","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":"{\"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}","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}
Distal Migration of the Pulmonary Artery Catheter During Cardiac Surgery With Cardiopulmonary Bypass Observed Using Transesophageal Echocardiography: A Prospective Observational Study.
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.
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.