The instability of most critically ill patients necessitates regular monitoring of hemodynamic parameters, including blood volume and pulmonary capillary wedge pressure (PCWP). However, the invasiveness and technological complexity of the standard modality restricts its usefulness to an eligible subset of patients with access to it. The vascular pedicle is a radiographic structure whose width may be a valid tool for assessing PCWP. This study aims to determine the diagnostic accuracy of the vascular pedicle width (VPW) in differentiating high from low-to-normal PCWP in critically ill cardiac patients from the Cardiac Care Unit of SLMC. Information from seventy-three chest radiographs, with corresponding PCWP tracings by Swan-Ganz pulmonary artery catheters were prospectively collected from June 2003 to January 2004. Three independent radiologists read the films, following a standard protocol for VPW measurement. Results show that the over-all sensitivity of the test is 59.3 percent, with a specificity of 73.9 percent, likelihood ratio (+) and (-) of 2.27 and 0.55, respectively. Stratified analyses suggest that the test is more useful when the radiograph is taken with the patient in the supine rather than semi-sitting position. It is also more useful in obese, rather than non-obese patients. In the absence of modalities that are less invasive, at the same time objective, available, and accessible, the VPW is a good alternative for the assessment of hemodynamic status in critically ill patients.

Critical Illness ; Pulmonary Wedge Pressure