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Relationship of arterial wedge pressure to closing pressure in the pulmonary circulation.

We studied the relationship between the pulmonary artery wedge pressure (Pw) and pulmonary venous pressure (Ppv) at 2 alveolar pressures (PA) in 7 isolated perfused dog lobes. If PA were the critical pressure in the pulmonary circulation, one would expect Pw to equal Ppv for all Ppv greater than PA. Relative to the hilum, the average critical pressure in these lobes was 15.07 +/- 0.40 cmH2O at PA = 5 cmH2O and increased significantly to 17.23 +/- 0.82 cmH2O at PA = 7 cmH2O. Because the critical pressure in fact exceeded PA, Pw was found to be relatively constant and independent of Ppv even when Ppv exceeded PA by 5 cmH2O or more. For example, at PA = 5.13 +/- 0.04 cmH2O and Ppv = 9.64 +/- 0.28, the mean value for Pw was 13.30 +/- 0.59 cmH2O. Pw is equal neither to the average critical pressure nor to PA, but instead lies between these two values. It is determined by the spectrum of closing pressures in the pulmonary circulation, and the time-constants for drainage of beds downstream from the occluded pulmonary arterial branch.