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Initial Clinical Experience With a Miniaturized Transesophageal Echocardiography Probe in a Cardiac Intensive Care Unit

Published:January 06, 2015DOI:https://doi.org/10.1053/j.jvca.2014.09.016

      Objective

      To investigate the safety of a novel, miniaturized, monoplane transesophageal echocardiography probe (mTEE) and its potential as a hemodynamic monitoring tool.

      Design

      This was a retrospective analysis of the clinical evaluation of a disposable mTEE in ventilated patients with severe cardiogenic shock requiring hemodynamic support. mTEE assessment was performed by operators with mixed levels of TEE training. Information on hemodynamic interventions based on mTEE findings was recorded.

      Setting

      A tertiary university cardiac critical care unit.

      Participants

      Male and female critical care patients admitted to the unit with severe hemodynamic instability.

      Interventions

      Insertion of miniaturized disposable TEE probe and hemodynamic and other critical care interventions based on this and conventional monitoring.

      Measurements and Main Results

      In 41 patients (51.2% female, 73.2% after cardiac surgery), hemodynamic support probe insertion was accomplished without major complications. A total of 195 mTEE studies were performed, resulting in changes in therapy in 37 (90.2%) patients based on mTEE findings, leading to an improvement in hemodynamic parameters in 33 (80.5%) patients. Right ventricular (RV) failure was diagnosed in 25 patients (67.6%) and mTEE had a direct therapeutic impact on management of RV failure in 17 patients (68 %).

      Conclusions

      Insertion and operation of a novel, miniaturized transoesophageal echocardiography probe can be performed for up to 72 hours without major complications. Repeated assessment using this device provides complementary information to invasive monitoring in the majority of patients and has an impact on hemodynamic management.

      Key Words

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      References

        • Pölönen P.
        • Ruokonen E.
        • Hippeläinen M.
        • et al.
        A prospective, randomized study of goal-oriented hemodynamic therapy in cardiac surgical patients.
        Anesth Analg. 2000; 90: 1052-1059
        • Pearse R.
        • Dawson D.
        • Fawcett J.
        • Rhodes A.
        • et al.
        Early goal-directed therapy after major surgery reduces complications and duration of hospital stay. A randomised, controlled trial.
        Crit Care. 2005; 9: 687-693
        • Aya H.D.
        • Cecconi M.
        • Hamilton M.
        • et al.
        Goal-directed therapy in cardiac surgery: a systematic review and meta-analysis.
        Br J Anaesth. 2013; 110: 510-517
        • Alhashemi J.A.
        • Cecconi M.
        • Hofer C.K.
        Cardiac output monitoring: an integrative perspective.
        Crit Care. 2011; 15: 214
        • Vignon P.
        • Mentec H.
        • Terré S.
        • et al.
        Diagnostic accuracy and therapeutic impact of transthoracic and transesophageal echocardiography in mechanically ventilated patients in the ICU.
        Chest. 1994; 106: 1829-1834
        • Slama M.
        • Novara A.
        • Van de Putte P.
        • et al.
        Diagnostic and therapeutic implications of transesophageal echocardiography in medical ICU patients with unexplained shock, hypoxemia, or suspected endocarditis.
        Intensive Care Med. 1996; 22: 916-922
        • Schmidlin D.
        • Schuepbach R.
        • Bernard E.
        • et al.
        Indications and impact of postoperative transesophageal echocardiography in cardiac surgical patients.
        Crit Care Med. 2001; 29: 2143-2148
        • Vieillard-Baron A.
        • Slama M.
        • Cholley B.
        • et al.
        Echocardiography in the intensive care unit: from evolution to revolution?.
        Intensive Care Med. 2008; 34: 243-249
        • American Society of Anaesthesiologists and Society of Cardiovascular Anesthesiologists Task Force on Transesophageal Echocardiography: Practice guidelines for perioperative transesophageal echocardiography.
        An updated report by the American Society of Anesthesiologists and the Society of Cardiovascular Anesthesiologists Task Force on Transesophageal Echocardiography..
        Anesthesiology. 2010; 112: 1084-1096
        • Mebazaa A.
        • Pitsis A.A.
        • Rudiger A.
        • et al.
        Clinical review: Practical recommendations on the management of perioperative heart failure in cardiac surgery.
        Crit Care. 2010; 14: 201
        • Sutton D.C.
        • Kluger R.
        Intraoperative transoesophageal echocardiography: impact on adult cardiac surgery.
        Anaesth Intensive Care. 1998; 26: 287-293
        • Couture P.
        • Denault A.Y.
        • McKenty S.
        • et al.
        Impact of routine use of intraoperative transesophageal echocardiography during cardiac surgery.
        Can J Anaesth. 2000; 47: 20-26
        • Forrest P.
        • Lovelock N.
        • Hu J.
        • et al.
        The impact of intraoperative transoesophageal echocardiography on an unselected cardiac surgical population: A review of 2,343 cases.
        Anaesth Intensive Care. 2002; 30: 734-741
        • Hogue C.W.
        • Lappas G.D.
        • Creswell L.L.
        • et al.
        Swallowing dysfunction after cardiac operations.
        J Thorac Cardiovasc Surg. 1995; 110: 517-522
        • Rousou J.A.
        • Tighe D.A.
        • Garb J.L.
        • et al.
        Risk of dysphagia after transesophageal echocardiography during cardiac operations.
        Ann Thorac Surg. 2000; 269: 486-490
        • Kallmeyer I.J.
        • Collard C.D.
        • Fox J.A.
        • et al.
        The safety of intraoperative transesophageal echocardiography: a case series of 7200 cardiac surgical patients.
        Anesth Analg. 2001; 92: 1126-1130
        • Lennon M.J.
        • Gibbs N.M.
        • Weightman W.M.
        • et al.
        Transesophageal echocardiography-related gastrointestinal complications in cardiac surgical patients.
        J Cardiothorac Vasc Anesth. 2005; 19: 141-145
        • Piercy M.
        • McNicol L.
        • Dinh D.T.
        • et al.
        Major complications related to the use of transesophageal echocardiography in cardiac surgery.
        J Cardiothorac Vasc Anesth. 2009; 23: 62-65
        • Spencer K.T.
        • Krauss D.
        • Thurn J.
        • et al.
        Transnasal transesophageal echocardiography.
        J Am Soc Echocardiogr. 2007; 10: 728-737
        • Spencer K.T.
        • Goldman M.
        • Cholley B.
        • et al.
        Multicenter experience using a new prototype transnasal transesophageal echocardiography probe.
        Echocardiography. 1999; 16: 811-817
        • Greim C.A.
        • Brederlau J.
        • Kraus I.
        • et al.
        Transnasal transesophageal echocardiography: a modified application mode for cardiac examination in ventilated patients.
        Anesth Analg. 1999; 88: 306-311
        • Zimmermann P.
        • Greim C.
        • Trautner H.
        • et al.
        Echocardiographic monitoring during induction of general anesthesia with a miniaturized esophageal probe.
        Anesth Analg. 2003; 96: 21-27
        • Benjamin E.
        • Griffin K.
        • Leibowitz A.
        • et al.
        Goal-directed transesophageal echocardiography performed by intensivists to assess left ventricular function: comparison with pulmonary artery catheterization.
        J Cardiothorac Vasc Anesth. 1998; 12: 10-15
        • Vignon P.
        • Amiel J.-B.
        • Francois B.
        • et al.
        Evaluation of a miniaturized TEE probe in ventilated ICU patients. Preliminary results.
        Intensive Care Med. 2012; 37: S242
        • Bick J.S.
        • McPherson J.A.
        • Schaff J.
        • et al.
        Initial experience with a disposable transesophageal echocardiography monitoring system during therapeutic hypothermia following out of hospital cardiac arrest.
        Internet J Emerg Intensive Care Med. 2012; 12: 2
        • Maltais S.
        • Costello W.T.
        • Billings F.T.
        • et al.
        Episodic Monoplane Echocardiography Impacts Postoperative Management of the Cardiac Surgery Patient.
        J Cardiothorac Vasc Anesth. 2013; 27: 665-669
        • Vieillard-Baron A.
        • Slama M.
        • Mayo P.
        • et al.
        A pilot study on safety and clinical utility of a single-use 72-hour indwelling transesophageal echocardiography probe.
        Intensive Care Med. 2013; 39: 629-635
        • Cioccari L.
        • Baur H.-R.
        • Berger D.
        • et al.
        Hemodynamic assessment of critically ill patients using a miniaturized transesophageal echocardiography probe.
        Crit Care. 2013; 17: R121
        • Charron C.
        • Vignon P.
        • Prat G.
        • et al.
        Number of supervised studies required to reach competence in advanced critical care transesophageal echocardiography.
        Intensive Care Med. 2013; 39: 1019-1024
        • Haddad F.
        • Couture P.
        • Tousignant C.
        • Denault A.Y.
        The right ventricle in cardiac surgery, a perioperative perspective: II. Pathophysiology, clinical importance, and management.
        Anesth Analg. 2009; 108: 422-433
        • Strumpher J.
        • Jacobsohn E.
        Pulmonary hypertension and right ventricular dysfunction: physiology and perioperative management.
        J Cardiothorac Vasc Anesth. 2011; 25: 687-704
        • Denault A.
        • Deschamps A.
        • Tardif J.C.
        • et al.
        Pulmonary hypertension in cardiac surgery.
        Curr Cardiol Rev. 2010; 6: 1-14
        • Fletcher S.N.
        • Grounds R.M.
        Critical care echocardiography: cleared for take up.
        Br J Anaesth. 2012; 109: 490-492
        • Geisen M.
        • Spray D.
        • Fletcher S.N.
        Echocardiography based haemodynamic management in the cardiac surgical ICU Review.
        J Cardiothorac Vasc Anaesth. 2014; 28: 733-744