Tissue Doppler imaging estimation of pulmonary artery occlusion pressure in ICU patients
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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.
Twenty-three consecutive mechanically ventilated patients.
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.
In mechanically ventilated ICU patients TTE or TEE E/E’ determinations using TDI closely approximate PAOP.
KeywordsEchocardiography, Doppler Ventricular function, left Pulmonary wedge pressure Intensive care units Respiration, artificial Prospective studies
The authors thank Dr. Dominique De Zuttere for his careful advises and critical review of the manuscript and Thierry Scheerlink (Toshiba Corp.) for providing the Toshiba Ultrasound Workstation UIWS-300A.
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