Continual hemodynamic monitoring with a single-use transesophageal echocardiography probe in critically ill patients with shock: a randomized controlled clinical trial.

Merz, Tobias; Cioccari, Luca; Frey, Pascal Marcel; Bloch, Andreas; Berger, David; Zante, Björn; Jakob, Stephan; Takala, Jukka (2019). Continual hemodynamic monitoring with a single-use transesophageal echocardiography probe in critically ill patients with shock: a randomized controlled clinical trial. Intensive care medicine, 45(8), pp. 1093-1102. Springer-Verlag 10.1007/s00134-019-05670-6

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PURPOSE Mortality in circulatory shock is high. Enhanced resolution of shock may improve outcomes. We aim to determine whether adding hemodynamic monitoring with continual transesophageal echocardiography (hTEE) to usual care accelerates resolution of hemodynamic instability. METHODS 550 patients with circulatory shock were randomly assigned to four groups stratified using hTEE (hTEE vs usual care) and assessment frequency (minimum every 4 h vs 8 h). Primary outcome was time to resolution of hemodynamic instability, analyzed as intention-to-treat (ITT) analysis at day 6 and in a predefined secondary analysis at days 3 and 28. RESULTS Of 550 randomized patients, 271 with hTEE and 274 patients with usual care were eligible and included in the ITT analysis. Time to resolution of hemodynamic instability did not differ within the first 6 days [hTEE vs usual care adjusted sub-hazard ratio (SHR) 1.20, 95% confidence interval (CI) 0.98-1.46, p = 0.067]. Time to resolution of hemodynamic instability during the 72 h of hTEE monitoring was shorter in patients with TEE (hTEE vs usual care SHR 1.26, 95% CI 1.02-1.55, p = 0.034). Assessment frequency had no influence. Time to resolution of clinical signs of hypoperfusion, duration of organ support, length of stay and mortality in the intensive care unit and hospital, and mortality at 28 days did not differ between groups. CONCLUSIONS In critically ill patients with shock, hTEE monitoring or hemodynamic assessment frequency did not influence resolution of hemodynamic instability or mortality within the first 6 days. TRIAL REGISTRATION AND STATISTICAL ANALYSIS PLAN ClinicalTrials.gov Identifier: NCT02048566.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic of Intensive Care
04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine

UniBE Contributor:

Merz, Tobias; Cioccari, Luca; Frey, Pascal Marcel; Bloch, Andreas; Berger, David; Zante, Björn; Jakob, Stephan and Takala, Jukka

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0342-4642

Publisher:

Springer-Verlag

Language:

English

Submitter:

Christine Baumgartner

Date Deposited:

26 Aug 2019 10:38

Last Modified:

26 Aug 2019 13:27

Publisher DOI:

10.1007/s00134-019-05670-6

Related URLs:

PubMed ID:

31273416

Uncontrolled Keywords:

Circulatory shock Hemodynamic monitoring Hemodynamic transesophageal echocardiography (hTEE) Randomized controlled trial

BORIS DOI:

10.7892/boris.132073

URI:

https://boris.unibe.ch/id/eprint/132073

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