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

Cioccari, Luca; Baur, Hans-Rudolf; Berger, David; Wiegand, Jan; Takala, Jukka; Merz, Tobias Michael (2013). Hemodynamic assessment of critically ill patients using a miniaturized transesophageal echocardiography probe. Critical care, 17(3), R121. BioMed Central 10.1186/cc12793

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INTRODUCTION Hemodynamic 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. METHODS In 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. RESULTS In 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). CONCLUSIONS Echocardiographic 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.

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

UniBE Contributor:

Cioccari, Luca; Berger, David; Wiegand, Jan; Takala, Jukka and Merz, Tobias Michael

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1364-8535

Publisher:

BioMed Central

Language:

English

Submitter:

Alessandra Angelini

Date Deposited:

04 Jul 2014 08:15

Last Modified:

11 Sep 2017 20:49

Publisher DOI:

10.1186/cc12793

PubMed ID:

23786797

Uncontrolled Keywords:

hemodynamic monitoring, trans-esophageal echocardiography, quality assessment, critical care

BORIS DOI:

10.7892/boris.54250

URI:

https://boris.unibe.ch/id/eprint/54250

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