If a pulmonary artery catheter shows an elevated CVP and MPAP, what is the recommended management?

The recommended management in this scenario is to initiate diuretics to decrease fluid overload. An elevated central venous pressure (CVP) along with an elevated mean pulmonary artery pressure (MPAP) typically indicates that there is excess fluid in the circulation, which can lead to complications such as pulmonary congestion and increased afterload on the heart.

By administering diuretics, the goal is to reduce the volume overload on the heart and lungs, which can help alleviate the elevated pressures observed. Diuretics promote renal excretion of sodium and water, thereby decreasing intravascular volume, which can lead to improved cardiac output and potentially lower pressures in both the venous and pulmonary arteries.

In contrast, increasing PEEP (positive end-expiratory pressure) might worsen lung compliance in the presence of fluid overload, as it can lead to further over-distension of already congested alveoli. Reducing PEEP may alleviate this issue but doesn't address the underlying fluid overload causing the elevated pressures. Increasing FIO2 could enhance oxygenation, but it does not tackle the primary problem of fluid overload and could be unnecessary if the underlying hemodynamics are not optimized. Therefore, initiating diuretics is the most direct approach to manage the elevated CVP and MPAP