Echocardiographic assessment of pulmonary artery occlusion pressure in ventilated patients: a transoesophageal study.
BACKGROUND
Non-invasive evaluation of left ventricular filling pressure has been scarcely studied in critically ill patients. Accordingly, we prospectively assessed the ability of transoesophageal echocardiography (TEE) Doppler to predict an invasive pulmonary artery occlusion pressure (PAOP) < or = 18 mmHg in ventilated patients.


METHODS
During two consecutive 3-year periods, TEE Doppler parameters were compared to right heart catheterisation derived PAOP used as reference in 88 ventilated patients, haemodynamically stable and in sinus rhythm (age: 63 +/- 14 years; simplified acute physiologic score (SAPS) II: 45 +/- 12). During the initial period (protocol A), threshold values of pulsed-wave Doppler parameters to predict an invasive PAOP < or = 18 mmHg were determined in 56 patients. Derived Doppler values were prospectively tested during the subsequent period (protocol B) in 32 patients.


RESULTS
In protocol A, Doppler parameters had similar area under the receiver operating characteristic (ROC) curve. In protocol B, mitral E/A < or = 1.4, pulmonary vein S/D > 0.65 and systolic fraction > 44% best predicted an invasive PAOP < or = 18 mmHg. Lateral E/E' < or = 8.0 or E/Vp < or = 1.7 predicted a PAOP < or = 18 mmHg with a sensitivity of 83% and 80%, and a specificity of 88% and 100%, respectively. Areas under ROC curves of lateral E/E' and E/Vp were similar (0.91 +/- 0.07 vs 0.92 +/- 0.07: p = 0.53), and not significantly different from those of pulsed-wave Doppler indices.


CONCLUSIONS
TEE accurately predicts invasive PAOP < or = 18 mmHg in ventilated patients. This further increases its diagnostic value in patients with suspected acute lung injury/acute respiratory distress syndrome.
Vignon
Philippe
P
Medical-surgical Intensive Care Unit, Dupuytren Teaching Hospital, 2 Ave, Martin Luther King, 87000 Limoges, France. philippe.vignon@unilim.fr
AitHssain
Ali
A
François
Bruno
B
Preux
Pierre-Marie
PM
Pichon
Nicolas
N
Clavel
Marc
M
Frat
Jean-Pierre
JP
Gastinne
Hervé
H
D000368:Aged; D006328:Cardiac Catheterization; D015150:Echocardiography, Doppler; D017548:Echocardiography, Transesophageal / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011651:Pulmonary Artery / Q000000981:diagnostic imaging*; D011669:Pulmonary Wedge Pressure; D012372:ROC Curve; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000175:diagnosis*