To the Editor.—
The authors of "Monitoring Resuscitation of the Injured Patient" (237:242, 1977) have attempted to simplify a complex task, but in so doing have entirely neglected a basic principle of vascular physiology. As a result, they have made recommendations that are frankly dangerous. They state that mean pulmonary artery pressure (PAP) "is the best single means for assessing adequacy of restoration of fluid volume," and that "continued fluid administration in the presence of an elevated PAP is hazardous and could lead to development or aggravation of posttraumatic pulmonary insufficiency." The authors would have encountered little disagreement if these statements had been made about the pulmonary artery wedge pressure rather than the mean pulmonary artery pressure. It is the pulmonary artery wedge pressure that most accurately reflects (1) the adequacy of volume restoration to maintain left ventricular filling pressure, and (2) the pulmonary venous pressure— hence the tendency for
Parham AM. Monitoring Resuscitation of the Injured Patient. JAMA. 1977;237(18):1928–1929. doi:10.1001/jama.1977.03270450018006
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