Transesophageal Pulsed Doppler echocardiography of pulmonary venous flow to assess left ventricular filling pressure in ventilated patients with acute respiratory distress syndrome.
OBJECTIVE
To determine whether the systolic fraction (SF) of the pulmonary venous flow (PVF), measured by transesophageal echocardiography (TEE) could be used to estimate the pulmonary artery occlusion pressure (PAOP).


METHODS
Prospective clinical investigation.


METHODS
Nineteen intubated patients with ARDS.


METHODS
Doppler examinations with measurement of the SF of the PVF (ie, the systolic velocity-time integral expressed as a fraction of the sum of systolic and early diastolic velocity-time integrals) were performed simultaneously with measurements of PAOP via a right heart catheter at 0 cmH2O PEEP (ZEEP), at PEEP = 8 cmH20 and at PEEP = 16 cmH2O.


RESULTS
At ZEEP, PAOP was inversely correlated with the SF of the PVF (r = -.89). The difference of SF between the group with PAOP <18 mm Hg and the group with PAOP > or = 18 mm Hg was statistically significant (P < .05). A SF > or = 55% predicted a PAOP < 15 mm Hg with a positive predictive value of 100% (95% CI = 63-100%). A SF < or = 40% predicted a PAOP > or =18 mm Hg with a positive predictive value of 100% (95% CI = 52-100%). At PEEP = 8 cm H20 (12 patients studied) and at PEEP = 16 cmH2O (10 patients studied), PAOP was inversely correlated with the SF of the PVF: r = -.84, and r = -.85, respectively.


CONCLUSIONS
The SF of the PVF measured by Pulsed Doppler TEE seems to be a valuable index to estimate the left ventricular filling pressure in mechanically ventilated patients with ARDS.
Département de Réanimation Médicale, Hôpital Pellegrin, Bordeaux Cedex, France. frederic.vargas@chu-bordeaux.fr
Frédéric
F
Vargas
Didier
D
Gruson
Ruddy
R
Valentino
Hoang Nam
HN
Bui
L Rachid
LR
Salmi
Véronique
V
Gilleron
Georges
G
Gbikpi-Benissan
Hervé
H
Guenard
Gilles
G
Hilbert
D001794:Blood Pressure; D015150:Echocardiography, Doppler; D017548:Echocardiography, Transesophageal; D006339:Heart Rate; D006801:Humans; D008875:Middle Aged; D011175:Positive-Pressure Respiration; D011652:Pulmonary Circulation; D011669:Pulmonary Wedge Pressure; D012128:Respiratory Distress Syndrome / Q000000981:diagnostic imaging / Q000628:therapy*