Anesth Pain Med.  2016 Oct;11(4):375-379. 10.17085/apm.2016.11.4.375.

Optimal transducer levels for central venous pressure and pulmonary artery occlusion pressure monitoring in supine and prone positions in pediatric patients

• Hur M
• Kim EH
• Song IK
• Lee JH
• Kim HS
• Kim JT

• KMID: 2358334
• DOI: http://doi.org/10.17085/apm.2016.11.4.375

Abstract

BACKGROUND
This study was performed to investigate optimal central venous pressure (CVP) or pulmonary artery occlusion pressure (PAOP) transducer levels in supine and prone positions in pediatric patients.
METHODS
Chest tomography images of 213 children aged ≤ 10 years were reviewed. Distances from the back to the uppermost blood level of both atria and their ratios to the largest anteroposterior (AP) diameter of the thorax were calculated for the supine position. For the prone position, same distances and ratios were calculated from the anterior chest. Subgroup analysis was performed to evaluate if there were significant differences in each ratio according to age.
RESULTS
In the supine position, the ratio of the uppermost blood level of the right atrium (RA) and left atrium (LA) to the largest AP diameter of the thorax was 80-85% and 60-65%, respectively. The ratio of the most posterior blood level of the RA and LA to largest AP diameter of thorax was 45-50% and 55-60%, respectively, from the anterior chest in the prone position. Subgroup differences in each ratio were within the range of 5%.
CONCLUSIONS
In pediatric patients, CVP and PAOP transducers should be differently placed according to supine and prone positions. The influence of age was minimal on the level of each transducer.

Keyword

Central venous pressure; Position; Transducer

MeSH Terms

Central Venous Pressure*
Child
Heart Atria
Humans
Prone Position*
Pulmonary Artery*
Supine Position
Thorax
Transducers*

Figure

• 

  Fig. 1 (A) Measurement of the uppermost blood level of the right atrium (RA) and the left atrium (LA) for supine position. RAsupine = the vertical distance from the skin on the back to the most anterior blood level of the RA; LAsupine = the vertical distance from the skin on the back to the most anterior blood level of the LA. (B) Measurement of the uppermost blood level of the RA and LA for prone position. RAprone = the vertical distance from the skin on the anterior chest wall to the most posterior portion of the right atrium; LAprone = the vertical distance from the skin on the anterior chest wall to the most posterior blood level of the LA. AP: anteroposterior.

• 

  Fig. 2 Influence of age on RAsupine/AP and LAsupine/AP. RAsupine/AP r2 = 0.059 (P < 0.001); LAsupine/AP r2 = 0.018 (P = 0.052). Asupine/AP = ratio of vertical distance from the skin on the back to the most anterior blood level of the RA to the largest AP diameter of the thorax in supine position; LAsupine/AP = ratio of vertical distance from the skin on the back to the most anterior blood level of the LA to the largest AP diameter of the thorax in supine position. RA: right atrium, AP: anteroposterior, LA: left atrium.

• 

  Fig. 3 Influence of age on RAprone/AP and LAprone/AP. RAprone/AP r2 = 0.084 (P < 0.001); LAprone/AP r2 = 0.043 (P = 0.002). RAprone/AP = ratio of vertical distance from the skin on the anterior chest wall to the most posterior blood level of the RA to the largest AP diameter of the thorax; LAprone/AP = ratio of vertical the skin on the anterior chest wall to the most posterior blood level of the LA to the largest AP diameter of the thorax. RA: right atrium, AP: anteroposterior, LA: left atrium.

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