Importance of transesophageal echocardiography in the critically ill and injured patient

Porembka, David T.

doi:10.1097/01.ccm.0000270279.72607.29

Cited by 32 publications

(9 citation statements)

References 103 publications

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“…Bedside echocardiography is considered a promising tool for the management of critically ill patients [13], and has been demonstrated to be useful in establishing the diagnosis and provides hemodynamic monitoring [14-16]. However, conventional TTE and TEE are not always readily available in an ICU setting.…”

Section: Discussionmentioning

confidence: 99%

Hemodynamic assessment of critically ill patients using a miniaturized transesophageal echocardiography probe

et al. 2013

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IntroductionHemodynamic management in intensive care patients guided by blood pressure and flow measurements often do not sufficiently reveal common hemodynamic problems. Trans-esophageal echocardiography (TEE) allows for direct measurement of cardiac volumes and function. A new miniaturized probe for TEE (mTEE) potentially provides a rapid and simplified approach to monitor cardiac function. The aim of the study was to assess the feasibility of hemodynamic monitoring using mTEE in critically ill patients after a brief operator training period.MethodsIn the context of the introduction of mTEE in a large ICU, 14 ICU staff specialists with no previous TEE experience received six hours of training as mTEE operators. The feasibility of mTEE and the quality of the obtained hemodynamic information were assessed. Three standard views were acquired in hemodynamically unstable patients: 1) for assessment of left ventricular function (LV) fractional area change (FAC) was obtained from a trans-gastric mid-esophageal short axis view, 2) right ventricular (RV) size was obtained from mid-esophageal four chamber view, and 3) superior vena cava collapsibility for detection of hypovolemia was assessed from mid-esophageal ascending aortic short axis view. Off-line blinded assessment by an expert cardiologist was considered as a reference. Inter-rater agreement was assessed using Chi-square tests or correlation analysis as appropriate.ResultsIn 55 patients, 148 mTEE examinations were performed. Acquisition of loops in sufficient quality was possible in 110 examinations for trans-gastric mid-esophageal short axis, 118 examinations for mid-esophageal four chamber and 125 examinations for mid-esophageal ascending aortic short axis view. Inter-rater agreement (Kappa) between ICU mTEE operators and the reference was 0.62 for estimates of LV function, 0.65 for RV dilatation, 0.76 for hypovolemia and 0.77 for occurrence of pericardial effusion (all P < 0.0001). There was a significant correlation between the FAC measured by ICU operators and the reference (r = 0.794, P (one-tailed) < 0.0001).ConclusionsEchocardiographic examinations using mTEE after brief bed-side training were feasible and of sufficient quality in a majority of examined ICU patients with good inter-rater reliability between mTEE operators and an expert cardiologist. Further studies are required to assess the impact of hemodynamic monitoring by mTEE on relevant patient outcomes.

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Section: Discussionmentioning

confidence: 99%

Hemodynamic assessment of critically ill patients using a miniaturized transesophageal echocardiography probe

et al. 2013

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“…Dyspnea, chest pain, and syncope are key symptoms that can lead to diagnosis, but these symptoms are absent in ICU patients who are under sedation and on mechanical ventilation [4]. In this scenario, after the development of sudden, severe hypotension, PE must be considered and included in a differential diagnosis according to the cause of admission [5]. TEE played a pivotal role in our patient due to the poor echocardiographic window, which is common in ICU patients.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, TEE has been shown to be of additional value in many instances for critically ill patients because of its ability to provide excellent visualization of cardiac structures. In this context, TTE has a diagnostic success rate of 50% and can occasionally lead to inadequate images that are not able to establish a diagnosis, compared with a 90% success rate for TEE [5]. TEE has 70% sensitivity and 81% specificity for the confirmation of PE [8].…”

Section: Discussionmentioning

confidence: 99%

“…The classic symptoms of PE are absent in intensive care unit (ICU) patients who are under sedation and on mechanical ventilation [4]. In this scenario, after the development of sudden, severe hypotension, PE must be considered and included as a differential diagnosis according to the cause of admission [5]. Our patient was admitted to the ICU with community-acquired pneumonia and was under sedation and mechanical ventilation and suddenly went into shock.…”

Section: Introductionmentioning

confidence: 99%

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Role of echocardiography in a patient with suspected acute pulmonary embolism: a case report

et al. 2019

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Background Approximately half of pulmonary embolism cases are diagnosed in an emergency context. The classic symptoms of pulmonary embolism are absent in intensive care unit patients who are under sedation and on mechanical ventilation. In this scenario, after the development of sudden, severe hypotension, pulmonary embolism must be considered and included in a differential diagnosis according to the cause of admission. Echocardiography may be of further help in a differential diagnosis of the cause of shock. Case presentation We present a case of a 44-year-old Caucasian man who was admitted to the intensive care unit with a diagnosis of community-acquired pneumonia and respiratory failure and who required invasive mechanical ventilation. During admission, the patient developed sudden, severe hypotension that was refractory to treatment. An adequate diagnosis with transthoracic echocardiography was unachievable because of a poor echocardiographic window. However, the combined use of electrocardiography and transesophageal echocardiography established pulmonary embolism as a high-probability diagnosis based on findings of right ventricular pressure overload and right ventricular dysfunction. The unfavorable hemodynamic situation of the patient prevented his transfer to carry out other complementary tests that could confirm the diagnosis of pulmonary embolism. Fibrinolytic and anticoagulant therapies were administered immediately, and a favorable clinical outcome was achieved. Conclusion This case highlights the fundamental role that echocardiography played in a patient in the intensive care unit who presented with shock secondary to pulmonary embolism with an unfavorable hemodynamic situation and in whom an unnecessary transfer to perform other complementary diagnostic tests was avoided. The combined use of electrocardiography and echocardiography provided a complete differential diagnosis, identifying the cause of shock and allowing the initiation of specific treatment without further delay. Knowledge of the echocardiographic results that are characteristic of pulmonary embolism can aid in the diagnosis. Electronic supplementary material The online version of this article (10.1186/s13256-019-1994-y) contains supplementary material, which is available to authorized users.

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“…9,10 As with all imaging techniques, its main limitation is dependency on operator experience and on the apparatus being used. 9,10 As with all imaging techniques, its main limitation is dependency on operator experience and on the apparatus being used.…”

Section: Usefulness Of Echocardiography In Situations Of Hemodynamic mentioning

confidence: 99%

Role of echocardiography in the hemodynamic monitorization of critical patients

Azcárate

Terré

Ochagavía

et al. 2012

Medicina Intensiva (English Edition)

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Importance of transesophageal echocardiography in the critically ill and injured patient

Cited by 32 publications

References 103 publications

Hemodynamic assessment of critically ill patients using a miniaturized transesophageal echocardiography probe

Hemodynamic assessment of critically ill patients using a miniaturized transesophageal echocardiography probe

Role of echocardiography in a patient with suspected acute pulmonary embolism: a case report

Role of echocardiography in the hemodynamic monitorization of critical patients

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