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).

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 > 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.

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.