Evaluation of hypoxemic patients with transesophageal echocardiography

Hoole, Stephen P.; Falter, Florian

doi:10.1097/01.ccm.0000270281.49924.aa

Cited by 14 publications

(6 citation statements)

References 57 publications

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“…In postsurgical patients admitted to ICU, hypoxemia is a common event and mainly due to pulmonary causes. Specifically, pulmonary thrombo‐endarterectomy is often complicated by a variable degree of postoperative hypoxemia, most frequently caused by early reperfusion edema (10–36%), a phenomenon highly responsive to PEEP, iNO, and negative water balance. Pulmonary causes of hypoxemia can be easily identified by lung sonography in ICU patients .…”

Section: Discussionmentioning

confidence: 99%

Patent foramen ovale diagnosis: The importance of provocative maneuvers

Mongodi

Via

Riccardi

et al. 2016

J of Clinical Ultrasound

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Patent foramen ovale (PFO) is a frequent congenital anomaly, but massive right-to-left shunt (RTLS) is normally prevented by higher pressures in left heart chambers. However, mechanical ventilation with positive end-expiratory pressure (PEEP) can significantly increase right atrial pressure, accentuating the RTLS, mainly after major cardiothoracic surgery. We report a patient admitted to the intensive care unit after cardiac surgery. Pre- and intraoperative transesophageal echocardiography only described an aneurysmal interatrial septum with no shunt. However, high-PEEP ventilation induced a paradoxical response with life-threatening hypoxemia, triggering further echocardiographic evaluation, revealing massive RTLS across a stretch PFO. Provocative maneuvers (Valsalva/PEEP) significantly increase echocardiographic sensitivity, unmasking silent PFO. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 45:58-61, 2017.

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Section: Discussionmentioning

confidence: 99%

Patent foramen ovale diagnosis: The importance of provocative maneuvers

Mongodi

Via

Riccardi

et al. 2016

J of Clinical Ultrasound

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“…TTE before anaesthesia or even in elective outpatient pre-admission anaesthetic clinics can help clinician in actual decision-making at the critical time for appropriate management. [ 7 8 9 10 ] Conventional first-line management of a patient in an unstable condition with fluid and vasopressor administration will work most of the times. However, in an unresponsive and unstable haemodynamic situation, TTE can provide information required for a rational approach for definitive clinical treatment.…”

Section: Clinical Applicationmentioning

confidence: 99%

“…Accuracy of POC TTE in the hands of novice is comparable with expert and has a positive impact on clinical situations. [ 7 8 9 10 11 ] It is also equally important to refer the findings of the patients appropriately and in timely fashion for long-term management and follow-up with cardiologists. Authors also acknowledge the huge task and responsibility of teaching and education of already practising anaesthetists.…”

Section: Limitations and Solutionsmentioning

confidence: 99%

Clinical application of point of care transthoracic echocardiography in perioperative period

Margale

Marudhachalam

Natani³

2017

Indian J Anaesth

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Transthoracic echocardiography (TTE) has established its role for diagnosis and management in cardiology and is used by various other specialities in medicine, but it is not routinely practised by anaesthesiologists in the perioperative period including the pre-admission clinic/outpatient clinic. The last decade has seen the emerging role of anaesthesiologist as a ’Perioperative physician’. This review article highlights the potential role and clinical utility, education, teaching and limitations of point of care (POC) TTE modality in perioperative care. Various echocardiography society guidelines and endorsements, diagnostic protocols and limitations are enumerated. This article also discusses some of the possibilities for future education and development related to clinical ultrasound including POC TTE in anaesthetic training curriculum.

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“…Transoesphageal echocardiography (TOE) enables accurate visualisation of the heart and great vessels. Pictures are achieved in real time and the use of TOE has been advocated to guide fluid resuscitation [7,8] Ultrasound Ultrasound generally is a modality that is becoming much more widespread in use. NICE guidance is that US should be used for neck line insertion in elective patients and should be available in for emergency insertions [9].…”

Section: Monitoringmentioning

confidence: 99%