Vignon et al used transesophageal echocardiography to determine the pulmonary artery occlusion pressure (PAOP) in a patient receiving mechanical ventilation. The authors are from Dupuytren Teaching Hospital, University of Limoges, Jean Bernard Teaching Hospital and Teaching Hospital (Clermont-Ferrand) in France.


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%


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