Initial Clinical Experience With a Miniaturized Transesophageal Echocardiography Probe in a Cardiac Intensive Care Unit

Fletcher, Nick; Geisen, Martin; Meeran, Hanif; Spray, David C.; Cecconi, Maurizio

doi:10.1053/j.jvca.2014.09.016

Cited by 21 publications

(17 citation statements)

References 32 publications

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“…Interestingly, hTEE monitoring detected new and/or clinically unexpected right ventricular (RV) dysfunction [19,33,34] in approximately one-third of the patients, comparable to a previous study [14]. Fletcher et al [19] also detected even more new right ventricular failure (67.6 %) in ventilated patients with severe cardiogenic shock requiring hemodynamic support using hTEE.…”

Section: Discussionsupporting

confidence: 74%

“…Fletcher et al [19] also detected even more new right ventricular failure (67.6 %) in ventilated patients with severe cardiogenic shock requiring hemodynamic support using hTEE. Also, one pericardial tamponade by monoplane hTEE was detected in a very early postoperative time frame with consequent re-operation [35][36][37][38][39].…”

Section: Discussionmentioning

confidence: 92%

“…Up to now, there have only been a few clinical trials investigating the possible benefit of using the ImaCor Ò ClariTEE Ò to guide hemodynamic therapy in high-risk surgical and/or critically ill patients [13][14][15][16][17][18][19]. Monoplane TEE in the hands of intensivists has been shown to provide clinically useful estimates of LV function, RV dilation, hypovolemia and occurrence of pericardial effusion, as shown evaluated by between experienced echocardiographers [16].…”

Section: Introductionmentioning

confidence: 99%

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Feasibility and influence of hTEE monitoring on postoperative management in cardiac surgery patients

Treskatsch

Balzer

Knebel

et al. 2015

Int J Cardiovasc Imaging

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Monoplane hemodynamic TEE (hTEE) monitoring (ImaCor(®) ClariTEE(®)) might be a useful alternative to continuously evaluate cardiovascular function and we aimed to investigate the feasibility and influence of hTEE monitoring on postoperative management in cardiac surgery patients. After IRB approval we reviewed the electronic data of cardiac surgery patients admitted to our intensive care between 01/01/2012 and 30/06/2013 in a case-controlled matched-pairs design. Patients were eligible for the study when they presented a sustained hemodynamic instability postoperatively with the clinical need of an extended hemodynamic monitoring: (a) hTEE (hTEE group, n = 18), or (b) transpulmonary thermodilution (control group, n = 18). hTEE was performed by ICU residents after receiving an approximately 6-h hTEE training session. For hTEE guided hemodynamic optimization an institutional algorithm was used. The hTEE probe was blindly inserted at the first attempt in all patients and image quality was at least judged to be adequate. The frequency of hemodynamic examinations was higher (ten complete hTEE examinations every 2.6 h) in contrast to the control group (one examination every 8 h). hTEE findings, including five unexpected right heart failure and one pericardial tamponade, led to a change of current therapy in 89% of patients. The cumulative dose of epinephrine was significantly reduced (p = 0.034) and levosimendan administration was significantly increased (p = 0.047) in the hTEE group. hTEE was non-inferior to the control group in guiding norepinephrine treatment (p = 0.038). hTEE monitoring performed by ICU residents was feasible and beneficially influenced the postoperative management of cardiac surgery patients.

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Section: Discussionsupporting

confidence: 74%

Section: Discussionmentioning

confidence: 92%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Feasibility and influence of hTEE monitoring on postoperative management in cardiac surgery patients

Treskatsch

Balzer

Knebel

et al. 2015

Int J Cardiovasc Imaging

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“…Simplified insertion and improved tolerance are among the potential benefits for hemodynamically unstable patients requiring mechanical ventilation [17, 18]. In the intensive care unit setting, hTEE provides supplementary information to invasive monitoring [19] and displays good interrater reliability when performed by nonexperienced operators [20]. Thus, hTEE theoretically provides a safer, faster, and more user-friendly assessment of hemodynamic status compared to TTE and continuous TEE.…”

Section: Discussionmentioning

confidence: 99%

“…In our case, close monitoring of VA-ECMO support with hTEE allowed us to better characterize a complex state of shock (cardiogenic and vasodilatory) [19]. Hence, we have a more appropriate initial resuscitation in the early phase of our patient's care.…”

Section: Discussionmentioning

confidence: 99%

Hemodynamic Transesophageal Echocardiography-Guided Venous-Arterial Extracorporeal Membrane Oxygenation Support in a Case of Giant Cell Myocarditis

Ripoll

Ratzlaff

Menke

et al. 2016

Case Reports in Critical Care

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Giant cell myocarditis (GCM) is a rare and commonly fatal form of fulminant myocarditis. During the acute phase, while immunosuppressive therapy is initiated, venoarterial extracorporeal membrane oxygenation (VA-ECMO) support is commonly used as a bridge to heart transplantation or recovery. Until recently, conventional transesophageal echocardiography and transthoracic echocardiography were the tools available for hemodynamic assessment of patients on this form of mechanical circulatory support. Nevertheless, both techniques have their limitations. We present a case of a 54-year-old man diagnosed with GCM requiring VA-ECMO support that was monitored under a novel miniaturized transesophageal echocardiography (hTEE) probe recently approved for 72 hours of continuous hemodynamic monitoring. Our case highlights the value of this novel, flexible, and disposable device for hemodynamic monitoring, accurate therapy guidance, and potential VA-ECMO weaning process of patients with this form of severe myocarditis.

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The ICM research agenda on critical care ultrasonography

Mayo¹,

Arntfield²,

Borggrefe³

et al. 2017

Intensive Care Med

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Initial Clinical Experience With a Miniaturized Transesophageal Echocardiography Probe in a Cardiac Intensive Care Unit

Cited by 21 publications

References 32 publications

Feasibility and influence of hTEE monitoring on postoperative management in cardiac surgery patients

Feasibility and influence of hTEE monitoring on postoperative management in cardiac surgery patients

Hemodynamic Transesophageal Echocardiography-Guided Venous-Arterial Extracorporeal Membrane Oxygenation Support in a Case of Giant Cell Myocarditis

The ICM research agenda on critical care ultrasonography

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