Transesophageal pulsed Doppler echocardiography of pulmonary venous flow to assess left ventricular filling pressure in ventilated patients with acute respiratory distress syndrome

Abstract

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). Design: Prospective clinical investigation. Patients: Nineteen intubated patients with ARDS. Interventions: 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. Measurements and Main 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 ≥ 18 mm Hg was statistically significant ( P < .05). A SF ≥ 55% predicted a PAOP < 15 mm Hg with a positive predictive value of 100% (95% CI = 63–100%). A SF ≤ 40% predicted a PAOP ≥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. Conclusion: 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.