Feasibility, Safety, and Utility of Advanced Critical Care Transesophageal Echocardiography Performed by Pulmonary/Critical Care Fellows in a Medical ICU

Complications related to peri‐operative transoesophageal echocardiography – a one‐year prospective national audit by the Association of Cardiothoracic Anaesthesia and Critical Care

“…Transoesophageal echocardiography is also utilised for other major surgical procedures such as liver or lung transplantation and surgery on the abdominal aorta . Furthermore, TOE is becoming an important tool in the critical care environment, particularly for the investigation of unexplained haemodynamic instability . A number of anaesthesia and critical care societies have published guidelines recommending the peri‐operative use of TOE and there has been an increase in the number of accreditations available for clinicians .…”

The Use of Transesophageal Echocardiography During Cardiac Arrest Resuscitation: A Literature Review

“…Our literature review indicated that the only published mention of training in the use of TEE in emergency departments and ICUs involved small sample groups . We did not find any comparisons of teaching methods.…”

“…Our literature review indicated that the only published mention of training in the use of TEE in emergency departments and ICUs involved small sample groups. 34,35 We did not find any comparisons of teaching methods. Ample populations and diverse physician specialists are needed to determine the effectiveness of TEE during resuscitation from cardiac arrest as well as the most effective teaching methods.…”

Response

“…The "local culture and the fellows' desire to practice TTE or TEE" were not considered an indication to perform the transesophageal echocardiographic study. 1 The next point is that the authors wonder "why conditions like acute cor pulmonale or left ventricular dysfunction were not recognized clinically before performing TEE"; we again point out that this was a group of patients with an undifferentiated shock state prior to TEE. Clinical examination alone will fail to determine many causes of a shock state, especially in those patients with a coexisting diagnosis, such as severe sepsis with shock and an unknown cardiomyopathy.…”

“…Patient and family engagement is an important priority for clinical care and research efforts. 1 Partnering with patients and their families can play an important role in safety, 2 leading to improved communication and better healthcare delivery. 3 Acute floor nurses at our hospital started the Partners in Healing program to involve family members in patient care and to help prepare patients and their families for discharge (Fig 1; e-Figs 1-3; e-Appendix 1).…”