Intensive Care Medicine

, Volume 30, Issue 1, pp 75–81

Tissue Doppler imaging estimation of pulmonary artery occlusion pressure in ICU patients

  • Alain Combes
  • Florence Arnoult
  • Jean-Louis Trouillet
Original

DOI: 10.1007/s00134-003-2039-x

Cite this article as:
Combes, A., Arnoult, F. & Trouillet, JL. Intensive Care Med (2004) 30: 75. doi:10.1007/s00134-003-2039-x

Abstract

Objective

Earlier reports suggested that transthoracic (TTE) determination of the ratio of mitral inflow E wave velocity to early diastolic mitral annulus velocity (E/E’) measured by tissue Doppler imaging (TDI) closely approximates PAOP in cardiac patients. However, the value of E/E’ for PAOP assessment in ICU patients has not been evaluated. This study assessed whether the E/E’ ratio provides an accurate estimation of pulmonary artery occlusion pressure (PAOP) in mechanically ventilated ICU patients.

Design and setting

Prospective, open, clinical study in the ICU of a university hospital.

Patients

Twenty-three consecutive mechanically ventilated patients.

Interventions

Volume expansion in 14 patients.

Measurements and results

Doppler TTE or TEE mitral inflow and TDI mitral annulus velocities were determined and compared with PAOP measured using a Swan-Ganz catheter. Of all the Doppler variables studied the best correlations were observed between PAOP and the lateral (r=0.84) and medial (r=0.76) annulus E/E’ ratio and remained highly significant when the analysis was restricted to TEE (r=0.91 and 0.86) or TTE (r=0.73 and 0.61). The sensitivities and specificities of estimating PAOP at 15 mmHg or higher were, respectively, 86% and 81% for lateral E/E’ above 7.5 and 76% and 80% for medial E/E’ above 9. PAOP changes after volume expansion (700±230 ml) were limited and accurately assessed by repeated E/E’ determinations.

Conclusions

In mechanically ventilated ICU patients TTE or TEE E/E’ determinations using TDI closely approximate PAOP.

Keywords

Echocardiography, Doppler Ventricular function, left Pulmonary wedge pressure Intensive care units Respiration, artificial Prospective studies 

Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • Alain Combes
    • 1
  • Florence Arnoult
    • 2
  • Jean-Louis Trouillet
    • 1
  1. 1.Réanimation Médicale,Institut de CardiologieAP-HP, Hôpital Pitié-SalpêtrièreParisFrance
  2. 2.Explorations fonctionnellesAP-HP, Hôpital BichatParisFrance

Personalised recommendations