"Failure to wedge" and pulmonary hypertension during pulmonary artery catheterization: a sign of totally occlusive pulmonary embolism.

摘要: Correctly diagnosing pulmonary embolism in the ICU can be very difficult, especially when cardiopulmonary disease is coexistent but unrelated. This study describes four hemodynamically unstable patients whom hypertension and an inability to obtain a wedge pressure during balloon flotation catheterization suggested total embolic occlusion of major artery segment distal catheter. The diagnosis was confirmed by angiography performed via catheter three patients, perfusion scan one patient. Streptokinase infused directly into two resolving both.