Impact of Critical Care Transesophageal Echocardiography in Medical–Surgical ICU Patients: Characteristics and Results From 274 Consecutive Examinations

Abstract

Our observational data support intensivist-performed TEE as being safe and therapeutically influential across a broad range of indications. Our program's demonstrated feasibility and impact may act as a model for TEE adoption in other North American ICUs.

Safety of Transesophageal Echocardiography Performed by Intensivists and Emergency Physicians in Critically Ill Patients With Coagulopathy and Thrombocytopenia: A Single-Center Experience

“…8,9 While TEE has long been viewed as safe in the perioperative [10][11] and elective 12 settings, there is less evidence in regard to the safety of TEE among patients in the intensive care unit (ICU). Arntfield et al 2 found no complications in their study of 274 IP-performed TEEs in critically ill patient population. Viellard-Baron et al 13 evaluated the safety and efficacy of a 72-hour indwelling miniaturized TEE probe in mechanically ventilated patients.…”

“…Transesophageal echocardiography (TEE) has been shown to be helpful when performed by an intensivist physician (IP) in critically ill patients. 1,2 Agreement between cardiologist-and IP-performed TEE is high when used for diagnoses commonly seen in critically ill patients. 3 Further, TEE has been shown to change management when performed by an emergency physician (EP) in patients presenting to the emergency department (ED) during and immediately after cardiac arrest, [4][5][6][7] and its application has recently been expanded to the prehospital environment.…”

Critical Care Transesophageal Echocardiography in Patients during the COVID-19 Pandemic

“…Specific applications of TEE in the management of critically ill patients include the identification of shock etiology, 34 determination of preload sensitivity, and monitoring of hemodynamic interventions. 14 The evaluation of patients in shock with TEE has been well described elsewhere, and although it is not necessarily different in the context of patients with COVID-19, there are a few considerations worth noting. On the basis of our experience and in line with the wide spectrum of practice and scalability of critical care echocardiography, the scope of TEE in these patients varies depending on operator skill set and the clinical question(s) at hand.…”

“…Common applications of TEE in critically ill patients include assessment of circulatory failure, hemodynamic monitoring, evaluation of unexplained hypoxemia, and cardiac arrest. [13][14][15] Early data suggest that SARS-CoV-2 is associated with multiple cardiovascular complications, including myocardial dysfunction as well as the presence of a hypercoagulable state, leading to an increased risk for venous thromboembolic events such as pulmonary embolism (PE). [16][17][18] Although TEE can offer valuable information in the assessment and management of patients with these complications, this modality may carry a heightened risk for viral transmission and should be therefore considered carefully.…”

Expanding our FoCUS: the utility of advanced echocardiography in the emergency department

“…The evidence base for TOE in cardiac arrest is sparse, and its use is not yet widespread. A case series of 54 TOE examinations in ED demonstrated diagnostic influence in 78% of cases and therapeutic impact in 67%, while another series of 55 TOEs undertaken during cardiac arrest demonstrated feasibility in the intensive care unit (ICU) . Although seventy years of unguided compressions have provided a net benefit across the total population of arrest victims, further research should be encouraged to investigate whether the technique can be evolved any further in the modern era.…”