Bibiana Cujec, MD; David H. Johnson, MD; Irvin Mayers, MD
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Cujec B, Johnson DH, Mayers I. Positive End-Expiratory Pressure and Shunting across Foramen Ovale. Ann Intern Med. 1994;120:620. doi: 10.7326/0003-4819-120-7-199404010-00020
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Published: Ann Intern Med. 1994;120(7):620.
We agree that blinding echocardiographers to the level of positive PEEP during the saline contrast studies used to diagnose patent foramen ovale would have been optimal. However, some second-generation ventilators had a distinctive sound on expiration after addition of PEEP, which precluded the ability to blind them. However, right-to-left intracardiac shunting was present both with and without PEEP in six of the seven patients in whom patent foramen ovale was diagnosed. One patient had a right-to-left shunt only on one setting of PEEP. So bias is unlikely. Diagnostic bias was minimized by using predetermined criteria for diagnosis of patent foramen ovale. Stollberger and coworkers  found that variability in the criteria used to diagnose a right-to-left intracardiac shunt was the main source of interobserver variability in the diagnosis of patent foramen ovale with contrast transesophageal echocardiography.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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