Hemodynamic assessment of ventilated ICU patients with cardiorespiratory failure using a miniaturized multiplane transesophageal echocardiography probe

Bégot, Emmanuelle; Dalmay, François; Etchecopar, Caroline; Clavel, M.; Pichon, Nicolas; François, Bruno; Lang, Roberto M.; Vignon, Philippe

doi:10.1007/s00134-015-3998-4

Cited by 19 publications

(8 citation statements)

References 42 publications

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“…Miniaturized transesophageal echocardiography probes have emerged that facilitate prolonged esophageal insertion for serial hemodynamic assessment of unstable ICU patients (97,98). Future monitoring systems will presumably become less invasive and incorporate latest technological and electronic innovations, including artificial intelligence and telemetry (31).…”

Section: Future Perspectivesmentioning

confidence: 99%

Continuous cardiac output assessment or serial echocardiography during septic shock resuscitation?

Vignon¹

2020

Ann Transl Med

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Septic shock is the leading cause of cardiovascular failure in the intensive care unit (ICU).Cardiac output is a primary component of global oxygen delivery to organs and a sensitive parameter of cardiovascular failure. Any mismatch between oxygen delivery and rapidly varying metabolic demand may result in tissue dysoxia, hence organ dysfunction. Since the intricate alterations of both vascular and cardiac function may rapidly and widely change over time, cardiac output should be measured repeatedly to characterize the type of shock, select the appropriate therapeutic intervention, and evaluate patient's response to therapy. Among the numerous techniques commercially available for measuring cardiac output, transpulmonary thermodilution (TPT) provides a continuous monitoring with external calibration capability, whereas critical care echocardiography (CCE) offers serial hemodynamic assessments. CCE allows early identification of potential sources of inaccuracy of TPT, including right ventricular failure, severe tricuspid or left-sided regurgitations, intracardiac shunt, very low flow states, or dynamic left ventricular outflow tract obstruction. In addition, CCE has the unique advantage of depicting the distinct components generating left ventricular stroke volume (large cavity size vs. preserved contractility), providing information on left ventricular diastolic properties and filling pressures, and assessing pulmonary artery pressure. Since inotropes may have deleterious effects if misused, their initiation should be based on the documentation of a cardiac dysfunction at the origin of the low flow state by CCE. Experts widely advocate using CCE as a first-line modality to initially evaluate the hemodynamic profile associated with shock, as opposed to more invasive techniques. Repeated assessments of both the efficacy (amplitude of the positive response) and tolerance (absence of side-effect) of therapeutic interventions are required to best guide patient management. Overall, TPT allowing continuous tracking of cardiac output variations and CCE appear complementary rather than mutually exclusive in patients with septic shock who require advanced hemodynamic monitoring.

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Section: Future Perspectivesmentioning

confidence: 99%

Continuous cardiac output assessment or serial echocardiography during septic shock resuscitation?

Vignon¹

2020

Ann Transl Med

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“…Specifically, this TEE probe may allow the diagnosis and follow-up of ACP by a strict qualitative single-plane two-dimensional image monitoring. Another miniaturized TEE probe (diameter 5.5 mm) with multiplane imaging and Doppler capabilities has also been successfully used in ventilated ICU patients with cardiopulmonary compromise [ 68 ]. However, the clinical value of these new miniaturized TEE probes has to be confirmed in ARDS patients.…”

Section: Acute Respiratory Distress Syndromementioning

confidence: 99%

Critical care ultrasonography in acute respiratory failure

et al. 2016

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Acute respiratory failure (ARF) is a leading indication for performing critical care ultrasonography (CCUS) which, in these patients, combines critical care echocardiography (CCE) and chest ultrasonography. CCE is ideally suited to guide the diagnostic work-up in patients presenting with ARF since it allows the assessment of left ventricular filling pressure and pulmonary artery pressure, and the identification of a potential underlying cardiopathy. In addition, CCE precisely depicts the consequences of pulmonary vascular lesions on right ventricular function and helps in adjusting the ventilator settings in patients sustaining moderate-to-severe acute respiratory distress syndrome. Similarly, CCE helps in identifying patients at high risk of ventilator weaning failure, depicts the mechanisms of weaning pulmonary edema in those patients who fail a spontaneous breathing trial, and guides tailored therapeutic strategy. In all these clinical settings, CCE provides unparalleled information on both the efficacy and tolerance of therapeutic changes. Chest ultrasonography provides further insights into pleural and lung abnormalities associated with ARF, irrespective of its origin. It also allows the assessment of the effects of treatment on lung aeration or pleural effusions. The major limitation of lung ultrasonography is that it is currently based on a qualitative approach in the absence of standardized quantification parameters. CCE combined with chest ultrasonography rapidly provides highly relevant information in patients sustaining ARF. A pragmatic strategy based on the serial use of CCUS for the management of patients presenting with ARF of various origins is detailed in the present manuscript.

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“…[ 10 ] The indications for TEECC include an inadequate view in TTE when assessing hemodynamic failure, unexplained hypotension in post-cardiac surgery patients, unexplained hypoxemia, and identification of preload sensitivity. [ 11 ] The recently developed miniaturized transesophageal echocardiography probes can remain inserted into the esophagus for a prolonged period without relevant side effects, [ 12 ] which could be a future direction for TEECC.…”

Section: Critical Care Transesophageal Echocardiography (Teecc) In Hemodynamic Therapymentioning

confidence: 99%

Applications of critical ultrasonography in hemodynamic therapy

Huang

Liu

Wang

2021

Chinese Medical Journal

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Critical ultrasonography (CUS) is used in almost every branch of critical care medicine because of rapid development of this technology. CUS enables goal-directed, continuous, and dynamic evaluation. The use of CUS in hemodynamic therapy provides a detailed understanding of hemodynamics and optimizes hemodynamic therapy. This article describes the current applications of CUS in hemodynamic therapy from various aspects.

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Hemodynamic assessment of ventilated ICU patients with cardiorespiratory failure using a miniaturized multiplane transesophageal echocardiography probe

Cited by 19 publications

References 42 publications

Continuous cardiac output assessment or serial echocardiography during septic shock resuscitation?

Continuous cardiac output assessment or serial echocardiography during septic shock resuscitation?

Critical care ultrasonography in acute respiratory failure

Applications of critical ultrasonography in hemodynamic therapy

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