• Philippe Vignon, Ali AitHssain, Bruno François, Pierre-Marie Preux, Nicolas Pichon, Marc Clavel, Jean-Pierre Frat, and Hervé Gastinne.
• Medical-surgical Intensive Care Unit, Dupuytren Teaching Hospital, 2 Ave, Martin Luther King, 87000 Limoges, France. philippe.vignon@unilim.fr
• Crit Care. 2008 Jan 1;12(1):R18.

BackgroundNon-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.MethodsDuring 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.ResultsIn 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.ConclusionTEE 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.

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