Patient selection: mechanical ventilation with shock and/or respiratory failure
Method: pulsed waver Doppler imaging during transesophageal echocardiography
Goal: prediction of a PAOP <= 18 mm Hg
Parameters diagnostic of the target PAOP (specificity 100%):
(1) mitral E velocity to A velocity (E/A) ratio (from mitral flow) <= 1.4
(2) pulmonary vein S to D wave (S/D) ratio (from pulmonary venous flow) > 0.65
Parameter associated with target PAOP (specificity 88%, positive predictive value 96%):
(1) systolic fraction on pulmonary vein Doppler > 44%
Additional parameters associated with target PAOP (specificity 63%, PPV 85%)
(1) deceleration time of early diastolic mitral E wave (from mitral flow) > 100 milliseconds
(2) atrial filling fraction on mitral Doppler > 31%
