Quality Assurance for Intraoperative Transesophageal Echocardiography Monitoring

Rafferty, Terence D.; LaMantia, K. R.; DAVIS, E.; Phillips, Daniel B.; Harris, Susan R; CARTER, J.; Ezekowitz, M. D.; McCloskey, Gerard; Godek, Henry; Jaeger, David D.; Kopriva, Charles J.; Barash, P. G.

doi:10.1097/00132586-199310000-00011

Cited by 4 publications

(10 citation statements)

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“…The percentage of reported examinations reached 82.4% and differed widely between observers. This is in accordance with results from a quality assurance programme reported by Rafferty 13 6 yr ago. The overall reporting frequency in that study was 88%, and inter-observer variability was clearly demonstrated as well.…”

Section: Comparison With Results From Other Studiessupporting

confidence: 92%

“…Unlike Rafferty, we did not evaluate the quality and completeness of video recording, but frequent reviewing of tapes at our institution showed that we must improve imaging and storing on tape. Inter-observer variability of some variables has been reported: record keeping and image quality, 13 FAC, 15 intra-operative decision-making, 7 theoretical background, and image interpretation. 14 It is probably not possible, however, to eliminate observer variability by more intensive training, as it is very dif®cult to convince experienced anaesthetists to use uniform anaesthetic techniques and/or decision algorithms for any given clinical situation.…”

Section: Comparison With Results From Other Studiesmentioning

confidence: 99%

“…13 The 11 observers performed different numbers of TOE examinations and had different levels of experience. Thus, we would expect a signi®cant observer-dependence because of individual differences in skill.…”

Section: Major Limitations Of This Studymentioning

confidence: 99%

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Transoesophageal echocardiography in cardiac and vascular surgery: implications and observer variability

Schmidlin¹,

Béttex²,

Bernard³

et al. 2001

British Journal of Anaesthesia

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Transoesophageal echocardiography (TOE) has gained widespread acceptance among cardiac anaesthetists as a tool to facilitate peri-operative decision-making. This observational study analyses the impact of TOE and its inter-observer variability on intra-operative patient management during cardiac and major vascular surgery. From June 1996 to December 1998, standardized reports were obtained from 11 anaesthetists in 1891 adult cardiac and vascular surgery patients undergoing routine biplane or multiplane TOE. Inter-observer variability and the difference between variables of interest were tested using the chi-squared test or factorial analysis of variance as appropriate. TOE examinations were performed before and after the operation; 1673 (88.5%) patients underwent cardiopulmonary bypass (CPB), and 218 (11.5%) patients had surgery without CPB, including 42 (2.2%) coronary revascularizations. In 923 patients (49%), TOE provided additional information that in¯uenced the patient's therapy. In 968 patients (51%), TOE had only minor or no impact on clinical decision-making. In two patients (0.10%) the scheduled operation was not performed, and in another two patients the TOE examination led to major complications. Observer-dependent variables were: implications of TOE for intraoperative decision-making (P<0.0001), estimation of image quality (P<0.0001), pre-operative left ventricular fractional area change (FAC) (P=0.0026), difference between pre-operative FAC and post-operative FAC (P=0.033), and requests for supervision (P<0.0001). There was no signi®cant difference in the case mix between observers. TOE had an important impact on intraoperative patient management. Inter-observer variability was signi®cant for several variables but not for the frequency of additional surgical procedures.

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Section: Comparison With Results From Other Studiessupporting

confidence: 92%

Section: Comparison With Results From Other Studiesmentioning

confidence: 99%

See 1 more Smart Citation

Transoesophageal echocardiography in cardiac and vascular surgery: implications and observer variability

Schmidlin¹,

Béttex²,

Bernard³

et al. 2001

British Journal of Anaesthesia

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“…Dental trauma, 39 jaw subluxation, 20,40 tonsillar bleeding, erosion, and submucosal hematoma of the pharyngeal area 22,41 are some of the injuries related to TEE probe insertion of the upper gastrointestinal (GI) tract.…”

Section: Injuries Perforation Laceration and Tear Of The Gastroesopmentioning

confidence: 99%

“…196 It is essential to properly store the probe holder and the probe, itself, and to protect its distal part. [197][198][199][200] Prior to TEE examination, the probe must be inspected for both mechanical dysfunction and for damage to the flexible outer sheath that can collect contaminated fluid causing electrical or thermal injuries, 39 potentially resulting in arrhythmia and death 201 or to a steel wire damage of the esophageal mucosa. 202 The control system must be unlocked at all times to ensure probe flexibility and to prevent esophageal tear by rigid tubes.…”

Section: Viii-echocardiographer Expertisementioning

confidence: 99%

Transesophageal echocardiography-related complications

Côté

Denault

2008

Can J Anesth/J Can Anesth

106

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Purpose: The use of transesophageal echocardiography has increased over the past several years. It is generally considered a safe diagnostic and monitoring tool. Whereas complications associated with echocardiographic examination rarely occur, such complications must be known to echocardiographers performing these examinations. The purpose of this review is to summarize potential complications associated with transesophageal echocardiography. Sources:A systematic search of the English and French literature was undertaken using PubMed from the National Library of Medicine. Relevant articles were obtained from a Medline search spanning the years 1975 -2007, and their reference lists were used to retrieve additional articles. Principal findings:Complications of transesophageal echocardiography are primarily related to the gastrointestinal, cardiovascular, and respiratory systems, and include infection, toxic drug reaction, local reaction through contamination of the probe, and ultrasound cavitation. Strategies to prevent these complications are reviewed. Conclusion:Whereas transesophageal echocardiography is associated with a low complication rate, the echocardiographer must be knowledgeable about the types of complications and their predisposing factors, and should be meticulous in preventing their occurrence.

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TEE in Anästhesie und Intensivmedizin

Hm¹,

Poelaert²,

H³

1997

Der Anaesthesist

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Transoesophageal echocardiography (TEE) is recognised as a semi-invasive technique that has an increasing impact as a diagnostic tool in anaesthesia and intensive care medicine. However, adequate assessment of TEE is based on knowledge of basic echocardiographic principles and their limitations and sufficient educational training of the user. TEE has an established role in various clinical circumstances. It often saves time-consuming investigations for the diagnosis of aortic injuries in trauma patients. It is also useful in patients undergoing cardiac valve repair or congenital heart surgery with regard to assessment of the operative success. In patients with severe hypotension TEE may identify the cause, and thereby facilitate successful patient management. Moreover, TEE has an impact on the diagnosis of endocarditis and pathologic findings within the heart and pericardial sac. TEE-associated diagnosis and decision-making may lead to an improved clinical outcome, which in turn may lead to subsequent cost reduction.

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Quality Assurance for Intraoperative Transesophageal Echocardiography Monitoring

Cited by 4 publications

References 0 publications

Transoesophageal echocardiography in cardiac and vascular surgery: implications and observer variability

Transoesophageal echocardiography in cardiac and vascular surgery: implications and observer variability

Transesophageal echocardiography-related complications

TEE in Anästhesie und Intensivmedizin

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