• K Rizvi, B P Deboisblanc, J D Truwit, G Dhillon, A Arroliga, B D Fuchs, K K Guntupalli, D Hite, D Hayden, and NIH/NHLBI ARDS Clinical Trials Network.
• Division of Biological Sciences, University of Chicago Pritzker School of Medicine, Chicago, IL, USA.
• Crit. Care Med. 2005 Jan 1;33(1):98-103; discussion 243-4.

BackgroundPrevious investigations have identified significant interobserver variability in the measurements of central venous pressure and pulmonary artery occlusion pressure in critically ill patients. Large interobserver variability in the measurement of vascular pressures could potentially lead to inappropriate treatment decisions.ObjectiveWe postulated that adding an airway pressure signal (Paw) to pressure tracings of central venous pressure and pulmonary artery occlusion pressure would improve interobserver agreement by facilitating identification of end-expiration.DesignTo test this hypothesis, six independent experts used a standard protocol to interpret strip-chart recordings of central venous pressure and pulmonary artery occlusion pressure with or without Paw. Two observers were said to agree if their measurements were within 2 mm Hg of each other. SETTING/SUBJECTS/INTERVENTIONS: A total of 459 strip-chart recordings (303 without Paw and 156 with Paw) were obtained from 121 patients enrolled in the ARDSnet Fluids and Catheters Treatment Trial (FACTT) in 16 different hospitals.ResultsAgreement within 2 mm Hg between two measurements was 79% for central venous pressure strips without Paw vs. 86% with Paw. For pulmonary artery occlusion pressure, agreement increased from 71% without Paw to 83% with Paw. The increase in agreement with the addition of Paw was greater for strips demonstrating >8 mm Hg phasic respiratory variation compared with strips demonstrating less phasic respiratory variation.ConclusionPaw display is a simple, inexpensive method to facilitate the identification of end-expiration that can significantly improve interobserver agreement.

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