Echocardiographic Doppler Assessment of Pulmonary Capillary Wedge Pressure in Surgical Patients with Postoperative Circulatory Shock and Acute Lung Injury

Abstract

In patients with postoperative circulatory shock and acute lung injury, transesophageal echocardiography estimates noninvasively PCWP. However, echocardiographic estimation of PCWP may not be accurate enough for adjusting therapy.

Early fluid loading in acute respiratory distress syndrome with septic shock deteriorates lung aeration without impairing arterial oxygenation: a lung ultrasound observational study

“…The protocol was approved by the local Ethical Committee ( Comité de Protection des Personnes , Ile de France VI, Groupe Hospitalier Pitié-Salpêtrière, Paris, France, session nº18/2011) who considered the study an integral part of care provided to patients with ARDS and septic shock and waived the need for patients to give written informed consent. In our ICU, such patients are routinely monitored using a PiCCO or a fiber optic Swan-Ganz catheter [14-16] and transthoracic lung ultrasound is a common procedure to assess changes in lung aeration [6,7,17]. Thirty-two mechanically ventilated patients were included within 48 h following onset of septic shock and ARDS, defined according to referent recommendations [18,19].…”

Integrating lung ultrasound in the hemodynamic evaluation of acute circulatory failure (the fluid administration limited by lung sonography protocol)

“…However, "preload independence" of early diastolic mitral annulus motion (E′) is still debatable, and the effects of acute alterations in preload, afterload, and contractility on E′ and their related influence on E/E′ have not been proved [58,61]. Recent studies performed in critical care patients have tried to correlate E/E′ and PAOP with variable success [60][61][62][63][64]. Echocardiographic guidelines suggested that an E/ E′ ratio less than 8 accurately identified patients with a normal pressure and a ratio greater than 15 those with an elevated PAOP.…”

“…In patients with intermediate values (N8 and b15), PAOP may vary widely, and the other Doppler flow methods can be used [65]. Finally, TTE may provide simple logistics for grading LV diastolic dysfunction by using pulsed and tissue Doppler at the mitral valve and at the mitral annulus, facilitating thus cardiac function analysis in various cardiodynamic scenarios [60][61][62][63][64][65]. Notably, B predominance in LU does not always reflect elevated PAOP in shock states (Fig.…”

Current clinical applications of spectral tissue Doppler echocardiography (E/E' ratio) as a noninvasive surrogate for left ventricular diastolic pressures in the diagnosis of heart failure with preserved left ventricular systolic function

“…Some studies have also established that variations in E/E' accurately track changes in LV diastolic pressures under (un)loading therapy [48,55,56]. Clinical studies that found significant correlation between the spectral E/E' ratio and invasively determined pulmonary capillary wedge pressure or mean LV diastolic pressure in the setting of preserved LV systolic function are listed in Table 1.…”