Pulmonary Edema: Which Role for Echocardiography in the Diagnostic Workup?

Vignon, Philippe; Colreavy, Frances; Slama, Michel

doi:10.1007/978-3-540-87956-5_16

Cited by 3 publications

(3 citation statements)

References 55 publications

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“…Accordingly, conventional Doppler parameters are not recommended to diagnose left-ventricular diastolic dysfunction. Nevertheless, some of them have been validated in ventilated ICU patients for the identification of elevated pulmonary artery occlusion pressure (PAOP), typically associated with altered left-ventricular diastolic properties [10]. Tissue Doppler measures the velocity of change in myocardial length.…”

Section: Diagnosis Of Left-ventricular Diastolic Dysfunctionmentioning

confidence: 99%

Ventricular diastolic abnormalities in the critically ill

Vignon

2013

Current Opinion in Critical Care

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Section: Diagnosis Of Left-ventricular Diastolic Dysfunctionmentioning

confidence: 99%

Ventricular diastolic abnormalities in the critically ill

Vignon

2013

Current Opinion in Critical Care

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“…Critical care ultrasonography is best suited to precisely identify both the diagnosis and mechanism of weaning failure of cardiac origin, since it combines transthoracic echocardiography and chest ultrasonography which are portable, non-invasive, and easy-to-use imaging methods (10,16). In patients with acute respiratory failure, the echocardiographic diagnosis of cardiogenic pulmonary edema relies on the identification of elevated LV filling pressures which are usually associated with a LV diastolic dysfunction of variable severity, irrespective of systolic function (17). Accordingly, the same diagnostic approach applies for WiPO resulting in a failed SBT or in a failed extubation.…”

Section: Transthoracic Echocardiographymentioning

confidence: 99%

“…A significant increase of E' maximal velocity reflecting improved LV relaxation during SBT could constitute an additional factor predicting a successful weaning (21). In contrast, early clinical failure (typically within a few minutes) of SBT should trigger a prompt CCE assessment to confirm the WiPO (elevated LV filling pressure) and to depict its precise mechanism (17). In this case, additional transesophageal echocardiographic assessment may be performed once the patient has been sedated and reconnected to the ventilator in the presence of suboptimal surface image quality (10,46).…”

Section: Increased Extravascular Lung Watermentioning

confidence: 99%

Cardiovascular failure and weaning

Vignon

2018

Ann. Transl. Med.

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Cardiac patients are at high risk of weaning failure due to the abrupt burden to the cardiovascular system resulting from the transition from positive-pressure ventilation to spontaneous breathing. Similarly, numerous patients with borderline cardiac function, left ventricular diastolic dysfunction, chronic obstructive pulmonary disease, especially with associated fluid overload or cumulative positive fluid balance, are at high risk of weaning failure of cardiac origin. The diagnosis of weaning-induced pulmonary oedema (WiPO) relies on the measurement of elevated left ventricular filling pressure, or on the presence of a surrogate reflecting pulmonary or cardiac congestion. Plasma concentration of B-type natriuretic peptide and N-terminal proBNP, biological signs of hemoconcentration (increased circulating protein or hemoglobin levels), or measurement of extravascular pulmonary lung water using transpulmonary thermodilution have been proved valuable surrogates for the identification of weaning failure. Nevertheless, studies have not yet compared these indirect methods to precisely determine their respective diagnostic values for the identification of WiPO, especially in heart failure patients. In addition, none of these approaches directly assess left ventricular filling pressure and the mechanism of WiPO. In contrast, critical care echocardiography is ideally suited to establish the diagnosis of weaning failure of cardiac origin. It allows identifying the high-risk population, monitoring hemodynamically the patient at risk, depicting an abrupt increase of left ventricular filling pressure consistent with WiPO when the patient fails weaning, identifying the underlying mechanism of WiPO, and finally it allows tailoring the therapeutic management of the patient who failed weaning. The impact on patient-centered outcomes of such integrated management strategy based on critical care echocardiography deserves to be prospectively tested in a large population of patients at high risk of weaning failure of cardiac origin.

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The Role of the Heart in Weaning Failure

Guarracino

Brizzi

2020

Practical Trends in Anesthesia and Intensive Care 2019

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Pulmonary Edema: Which Role for Echocardiography in the Diagnostic Workup?

Cited by 3 publications

References 55 publications

Ventricular diastolic abnormalities in the critically ill

Ventricular diastolic abnormalities in the critically ill

Cardiovascular failure and weaning

The Role of the Heart in Weaning Failure

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