Positive End-expiratory Pressure Influences Echocardiographic Measures of Diastolic Function

Juhl-Olsen, Peter; Hermansen, Johan Fridolf; Frederiksen, Christian Alcaraz; Rasmussen, Linda Aagaard; Jakobsen, Carl-Johan; Sloth, Erik

doi:10.1097/aln.0b013e3182a10b40

Cited by 38 publications

(33 citation statements)

References 24 publications

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“…Advanced methods for quantitative assessment of diastolic function have been developed and include pulsed wave and tissue Doppler imaging. However, the intraoperative validity of these indices has been disputed [51].…”

Section: Diastolic Functionmentioning

confidence: 99%

Transthoracic echocardiography in the perioperative setting

Jørgensen¹,

Juhl-Olsen²,

Frederiksen

et al. 2016

Current Opinion in Anaesthesiology

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Hemodynamically significant cardiac disease or pathophysiology can be disclosed using TTE. Focused TTE is feasible for perioperative patient management and monitoring and will be an inevitable and indispensable tool for the anesthetist. Future research should focus on the outcome of perioperative TTE performed by anesthetists, using rigorous study designs and patient-centered outcomes such as mortality and morbidity.

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Section: Diastolic Functionmentioning

confidence: 99%

Transthoracic echocardiography in the perioperative setting

Jørgensen¹,

Juhl-Olsen²,

Frederiksen

et al. 2016

Current Opinion in Anaesthesiology

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“…Lung hyperinflation can decrease pulmonary vascular resistance when the volume increase is less than the functional reserve capacity but beyond this will increase the resistance with subsequent effects on right ventricular afterload and left ventricular preload. A lowering of the transmural pressure decreases afterload of the left-sided chambers, resulting in an increase in left atrial contractility and subsequent augmentation of ventricular filling, theoretically increasing A and a’, and even E and e′ [26]. In critically ill patients an E/e′ >13 is indicative of elevated left atrial pressure and, although very useful, is not without controversy [27, 28].…”

Section: Cardiogenic Shockmentioning

confidence: 99%

Echocardiography in shock management

McLean

2016

Crit Care

113

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Echocardiography is pivotal in the diagnosis and management of the shocked patient. Important characteristics in the setting of shock are that it is non-invasive and can be rapidly applied.In the acute situation a basic study often yields immediate results allowing for the initiation of therapy, while a follow-up advanced study brings the advantage of further refining the diagnosis and providing an in-depth hemodynamic assessment. Competency in basic critical care echocardiography is now regarded as a mandatory part of critical care training with clear guidelines available. The majority of pathologies found in shocked patients are readily identified using basic level 2D and M-mode echocardiography. A more comprehensive diagnosis can be achieved with advanced levels of competency, for which practice guidelines are also now available. Hemodynamic evaluation and ongoing monitoring are possible with advanced levels of competency, which includes the use of colour Doppler, spectral Doppler, and tissue Doppler imaging and occasionally the use of more recent technological advances such as 3D or speckled tracking.The four core types of shock—cardiogenic, hypovolemic, obstructive, and vasoplegic—can readily be identified by echocardiography. Even within each of the main headings contained in the shock classification, a variety of pathologies may be the cause and echocardiography will differentiate which of these is responsible. Increasingly, as a result of more complex and elderly patients, the shock may be multifactorial, such as a combination of cardiogenic and septic shock or hypovolemia and ventricular outflow obstruction.The diagnostic benefit of echocardiography in the shocked patient is obvious. The increasing prevalence of critical care physicians experienced in advanced techniques means echocardiography often supplants the need for more invasive hemodynamic assessment and monitoring in shock.

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“…[7] Perioperatively, patients under general anesthesia are under positive pressure ventilation, are usually in the supine position, frequently receive inotropes and vasopressors, can have extensive fluid shifts, are frequently paced, and undergo surgical insult, many of which can affect lusitropy, myocardial compliance, and filling pressures. [789] In addition, TEE, in comparison to TTE, has limitations in optimizing insonation angle, frequently provides better views of the posterior aspects of the heart, and may or may not provide good visualization of the anterior aspects of the heart. [10]…”

Section: Perioperative Echocardiographymentioning

confidence: 99%

Echo for diastology

Morrissey

2016

Ann Card Anaesth

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Diastolic dysfunction ranging from impaired relaxation of the left ventricle to heart failure with preserved ejection fraction (HFpEF) is a common finding in the cardiac surgery population. It is important for the peri-operative echocardiographer to have a developed understanding of the pathophysiology of diastolic dysfunction and the echocardiographic features that determine where on the spectrum of diastolic function and dysfunction a patient lies

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Positive End-expiratory Pressure Influences Echocardiographic Measures of Diastolic Function

Abstract: When evaluating diastolic function by echocardiography, the levels of PEEP and its effect on ventricular area have to be taken into account. In addition, this study dissuades the use of E/e' for tracking changes in left ventricular filling pressures in cardiac surgery patients.

Cited by 38 publications

References 24 publications

Transthoracic echocardiography in the perioperative setting

Transthoracic echocardiography in the perioperative setting

Echocardiography in shock management

Echo for diastology

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