A 70-year-old male with past medical history of mild-moderate mitral regurgitation and moderate-severe tricuspid regurgitation, COPD, and secondary pulmonary hypertension presents to the Emergency Department with a fever and new cough. Vitals on presentation are notable for a blood pressure of 80/43, temperature of 38.7°C, and oxygen saturation of 80% on room air, which improves modestly with 6 L oxygen by nasal cannula. Chest radiograph shows multifocal airspace opacities suggestive of pneumonia, but not pulmonary edema. He is transferred to the ICU for intubation. Examination is also notable for cool extremities with +1 symmetric lower extremity edema. In determining whether to administer fluids to this patient to augment his mean arterial pressure, which of the following techniques would be LEAST helpful?
A. Pulmonary Arterial Catheter (PAC) Wrong Choice!
B. Central Venous Pressure (CVP) Correct Choice
C. Pulse pressure variation Wrong Choice!
D. Passive leg raise Wrong Choice!
Answer:B
A 70-year-old male with past medical history of mild-moderate mitral regurgitation and moderate-severe tricuspid regurgitation, COPD, and secondary pulmonary hypertension presents to the Emergency Department with a fever and new cough. Vitals on presentation are notable for a blood pressure of 80/43, temperature of 38.7°C, and oxygen saturation of 80% on room air, which improves modestly with 6 L oxygen by nasal cannula. Chest radiograph shows multifocal airspace opacities suggestive of pneumonia, but not pulmonary edema. He is transferred to the ICU for intubation. Examination is also notable for cool extremities with +1 symmetric lower extremity edema. In determining whether to administer fluids to this patient to augment his mean arterial pressure, which of the following techniques would be LEAST helpful?
A. Pulmonary Arterial Catheter (PAC) Wrong Choice! B. Central Venous Pressure (CVP) Correct Choice C. Pulse pressure variation Wrong Choice! D. Passive leg raise Wrong Choice!