ClariTEE Probe ▼
Paul Boucher, Rakesh Arora, Gurmeet Singh, Yanick Beaulieu, Deirdre Hennessy, Christopher Doig
Oral abstract presented at ACCP Annual Meeting, October 28, 2008
The miniaturized TEE system was able to provide clinically useful images over time in 96% of patients. No complications were experienced during this study.
Better Hemodynamic Monitoring Tools are Needed ▼
- Goal-Directed Transesophageal Echocardiography Performed by Intensivists to Assess Left Ventricular Function: Comparison With Pulmonary Artery Catheterization
Ernest Benjamin, MD, FCCM, Kimberly Griffin, MD, Andrew B. Leibowitz, MD, Anthony Manasia, MD, John M. Oropello, MD, Virginia Geffroy, RN, Rosanna DelGiudice, RN, Jerry Hufanda, RN, Stacy Rosen, MD, and Martin Goldman, MD
Journal of Cardiothoracic and Vascular Anesthesia, Vol. 112, No. 1 (February), 1998: pp 10-15
Authors conclude that training intensivists in limited-scope, goal-directed TEE, using a pediatric monoplane probe to evaluate LV function, can be done rapidly and safely, and yield data pertinent to management of critically ill patients even in the early stages of skill acquisition.
Link
- A Randomized, Controlled Trial of the Use of Pulmonary-Artery Catheters in High-Risk Surgical Patients
James Dean Sandham, M.D., Russell Douglas Hull, M.B., B.S., Rollin Frederick Brant, Ph.D., Linda Knox, R.N., Graham Frederick Pineo, M.D., Christopher J. Doig, M.D., Denny P. Laporta, M.D., Sidney Viner, M.D., Louise Passerini, M.D., Hugh Devitt, M.D., Ann Kirby, M.D., and Michael Jacka, M.D.
N Engl J Med, Vol. 348, No. 1 (January), 2003: pp 5-14
Authors found no benefit to therapy directed by pulmonary-artery catheter over standard care in elderly, high-risk surgical patients requiring intensive care.
Link
- Assessment of Ventricular Function in Critically Ill Patients: Limitations of Pulmonary Artery Catheterization
Manuel L. Fontes, MD, Wayne Bellows, MD, Long Ngo, MS, and Dennis T. Mangano, PhD, MD
Journal of Cardiothoracic and Vascular Anesthesia, Vol. 113, No. 5 (October), 1999: pp 521-527
Authors report that both LV dysfunction and extremes of preload (hypovolemia or hypervolemia) are assessed poorly by clinicians using conventional clinical monitoring with pulmonary artery catheterization.
Link
- The Effectiveness of Right Heart Catheterization in the Initial Care of Critically Ill Patients
Alfred Connors, Jr, MD; Theodore Speroff, PhD; Neal V. Dawson, MD; Charles Thomas; Frank E. Harrell, Jr., PhD; William J. Fulkerson, Jr., MD; Humberto Vidaillet, MD; Steven Broste, MS; Paul Bellamy, MD; Joanne Lynn, MD; William A. Knaus, MD; for the SUPPORT Investigators
JAMA, 1996;276:889-897
Authors report that RHC was associated with increased mortality and increased utilization of resources.
Link
- Pulmonary artery occlusion pressure and central venous pressure fail to predict ventricular filling volume, cardiac performance, or the response to volume infusion in normal subjects
Anand Kumar, MD; Ramon Anel, MD; Eugene Bunnell, MD; Kalim Habet, MD, MD; Sergio Zanotti, MD; Stephanie Marshall, RN; Alex Neumann, MS; Amjad Ali, MD; Mary Cheang, MS; Clifford Kavinsky, MD, PhD; Joseph E. Parrillo, MD
Critical Care Medicine, Vol. 32, No. 3, 2004: pp 691-699
Concludes that neither central venous pressure nor pulmonary artery occlusion pressure appears to be a useful predictor of ventricular preload with respect to optimizing cardiac performance.
Link
TEE in Hemodynamically Unstable Patients ▼
- Role of Transesophageal Echocardiography in Hemodynamically Unstable Patients
Sohn DW, Shin GJ, Oh JK, Tajik AJ, Click RL, Miller FA Jr, Seward JB
http://www.ncbi.nlm.nih.gov/pubmed/7564542
Authors conclude that transesophageal echocardiography can be safely performed in hemodynamically unstable patients, it produces a high diagnostic yield, and it provides important information for prompt therapeutic decision making. Therefore, we recommend transesophageal echocardiography as one of the initial diagnostic procedures in critically ill patients suspected of having an underlying cardiovascular disorder.
- Echocardiographic measurement of fluid responsiveness
Vieillard-Baron A., Charron C, Chergui K., Peyrouset O., Jardin F
Intensive Care Med (2006) 32:1547–1552
“By its ability accurately to evaluate hemodynamic status qualitative TEE could be useful for intensivists in managing circulatory failure in septic shock, rendering the more time-consuming quantitative evaluation useless.”
Pro-forma Cost-Benefit Analysis ▼
MICU and Sepsis ▼
- Early Goal-Directed Therapy in the Treatment of Severe Sepsis and Septic Shock
Emanuel Rivers, M.D., M.P.H., Bryant Nguyen, M.D., Suzanne Havstad, M.A., Julie Ressler, B.S., Alexandria Muzzin, B.S., Bernhard Knoblich , M.D., Edward Peterson, PH.D., AND Michael Tomlanovich, M.D.
N Engl J Med, Vol. 345, No. 19 (November), 2001: pp 1368-77
Early goal-directed therapy provides significant benefits with respect to outcome in patients with severe sepsis and septic shock.
Link
- Actual incidence of global left ventricular hypokinesia in adult septic shock
Antoine Vieillard-Baron, MD; Vincent Caille, MD; Cyril Charron, MD; Guillaume Belliard, MD;
Crit Care Med, Vol. 36, No. 6, 2008: pp 1701–1706
Investigators report that global left ventricular hypokinesia is very frequent in adult septic shock and could be unmasked, in some patients, by norepinephrine treatment. Left ventricular hypokinesia is usually corrected by addition of an inotropic agent to the hemodynamic support.
Link
SICU / Non-cardiac Surgery / Trauma ▼
- Intraoperative Transesophageal Echocardiography During Noncardiac Surgery
Suriani RJ, Neustein, S, Shore-Lesserson L, Konstadt S.
Journal of Vascular Anesthesia, June 1998; 12(3): 274-80
Authors report that TEE in patients undergoing noncardiac surgery is efficacious in rapidly disclosing new findings and information during periods of hemodynamic instability. It may have a significant impact on intraoperative patient management and may be beneficial in patients older than 66 years of age.
Link
CTICU / Post-cardiac Surgery ▼
- The Hemodynamically Unstable Patient in the Intensive Care Unit: Hemodynamic vs. Transesophageal Echocardiographic Monitoring
Costachescu T, Denault A, Guimond JG, Couture P, Carignan S, Sheridan P, Hellou G, Blair L, Normandin L, Babin D, Allard M, Harel F, Buithieu J
Critical Care Medicine, June 2002;30(6):1214-23
Validation of TEE ▼
TEE is Safe ▼
- Clinical features of complications from transesophageal echocardiography: a single-center case series of 10,000 consecutive examinations.
Min JK, Spencer KT, Furlong KT, DeCara JM, Sugeng L, Ward RP, Lang RM
Journal of the American Society of Echocardiography, Vol. 18, No. 9 (September), 2005: pp 925-929
- Usefulness of Transesophageal Echocardiography in the Treatment of Critically Ill Patients
Hwang JJ, Shyu KG, Chen JJ, Tseng YZ, Kuan P, Lien WP
Chest, September 1993; 104(3):861-6
Transesophageal echocardiography was a safe, well-tolerated, and valuable diagnostic approach for the rapid detection of specific cardiac abnormalities in patients with critical illnesses; TEE should be considered in the treatment of critically ill patients especially when TEE provided inadequate information.
Link
- Role of Transesophageal Echocardiography in Hemodynamically Unstable Patients
Sohn DW, Shin GJ, Oh JK, Tajik AJ, Click RL, Miller FA Jr, Seward JB
Mayo Clinic Proceedings, October 1995; 70(10):925-31
Authors conclude that transesophageal echocardiography can be safely performed in hemodynamically unstable patients, it produces a high diagnostic yield, and it provides important information for prompt therapeutic decision making. Therefore, we recommend transesophageal echocardiography as one of the initial diagnostic procedures in critically ill patients suspected of having an underlying cardiovascular disorder.
Link
- Transesophageal Echocardiography in Critically Ill Patients
Colreavy FB, Donovan K, Lee KY, Weekes J
Critical Care Medicine, May 2002; 30(5): 989-96
Authors conclude that transesophageal echocardiography when performed by intensive care physicians is a safe procedure and provides useful information for the evaluation and management of critically ill patients.
Link
TEE in the ICU ▼
Paul Boucher, Rakesh Arora, Gurmeet Singh, Yanick Beaulieu, Deirdre Hennessy, Christopher Doig
Oral abstract presented at ACCP Annual Meeting, October 28, 2008
The miniaturized TEE system was able to provide clinically useful images over time in 96% of patients. No complications were experienced during this study.
- Actual incidence of global left ventricular hypokinesia in adult septic shock
Antoine Vieillard-Baron, MD; Vincent Caille, MD; Cyril Charron, MD; Guillaume Belliard, MD;
Crit Care Med, Vol. 36, No. 6, 2008: pp 1701–1706
Global left ventricular hypokinesia is very frequent in adult septic shock and could be unmasked, in some patients, by norepinephrine treatment. Left ventricular hypokinesia is usually corrected by addition of an inotropic agent to the hemodynamic support.
Link
- Role of Transesophageal Echocardiography in Hemodynamically Unstable Patients
Sohn DW, Shin GJ, Oh JK, Tajik AJ, Click RL, Miller FA Jr, Seward JB
Mayo Clinic Proceedings, October 1995; 70(10):925-31
Authors conclude that transesophageal echocardiography can be safely performed in hemodynamically unstable patients, it produces a high diagnostic yield, and it provides important information for prompt therapeutic decision making. Therefore, we recommend transesophageal echocardiography as one of the initial diagnostic procedures in critically ill patients suspected of having an underlying cardiovascular disorder.
Link
- The Hemodynamically Unstable Patient in the Intensive Care Unit: Hemodynamic vs. Transesophageal Echocardiographic Monitoring
Costachescu T, Denault A, Guimond JG, Couture P, Carignan S, Sheridan P, Hellou G, Blair L, Normandin L, Babin D, Allard M, Harel F, Buithieu J
Critical Care Medicine, June 2002;30(6):1214-23
These authors' observations support the belief that transesophageal echocardiographic monitoring in the intensive care unit is associated with higher interobserver agreement in diagnosing and excluding significant causes of hemodynamic instability for postoperative cardiac surgical patients.
Link
- Transesophageal Echocardiography in Critically Ill Patients
Colreavy FB, Donovan K, Lee KY, Weekes J
Critical Care Medicine, May 2002; 30(5): 989-96
Authors conclude that transesophageal echocardiography when performed by intensive care physicians is a safe procedure and provides useful information for the evaluation and management of critically ill patients.
Link
- Assessment of Ventricular Function in Critically Ill Patients: Limitations of Pulmonary Artery Catheterization
Manuel L. Fontes, MD, Wayne Bellows, MD, Long Ngo, MS, and Dennis T. Mangano, PhD, MD
Journal of Cardiothoracic and Vascular Anesthesia, Vol. 113, No. 5 (October), 1999: pp 521-527
Authors report that both LV dysfunction and extremes of preload (hypovolemia or hypervolemia) are assessed poorly by clinicians using conventional clinical monitoring with pulmonary artery catheterization.
Link
- The Use of Transesophageal Echocardiography for Preload Assessment in Critically Ill Patients
Claude P. Tousignant, MD, FRCPC, Fergus Walsh, MB, MRCPI, FFARCSI, and C. David Mazer, MD, FRCPC
Anesth Analg, Vol. 90, 2000: pp 351-355
This study provides evidence that the TEE gives information additive to the pulmonary artery catheter in the assessment of preload in an ICU population.
Link
Intensivists Can Perform Limited-Scope Echo ▼
Paul Boucher, Rakesh Arora, Gurmeet Singh, Yanick Beaulieu, Deirdre Hennessy, Christopher Doig
Oral abstract presented at ACCP Annual Meeting, October 28, 2008
The miniaturized TEE system was able to provide clinically useful images over time in 96% of patients. No complications were experienced during this study.
- Goal-Directed Transesophageal Echocardiography Performed by Intensivists to Assess Left Ventricular Function: Comparison With Pulmonary Artery Catheterization
Ernest Benjamin, MD, FCCM, Kimberly Griffin, MD, Andrew B. Leibowitz, MD, Anthony Manasia, MD, John M. Oropello, MD, Virginia Geffroy, RN, Rosanna DelGiudice, RN, Jerry Hufanda, RN,
Journal of Cardiothoracic and Vascular Anesthesia, Vol. 112, No. 1 (February), 1998: pp 10-15
Training intensivists in limited-scope, goal-directed TEE, using a pediatric monoplane probe to evaluate LV function, can be done rapidly and safely, and yield data pertinent to management of critically ill patients even in the early stages of skill acquisition.
Link
- Transesophageal Echocardiography in Critically Ill Patients
Colreavy FB, Donovan K, Lee KY, Weekes J
Critical Care Medicine, May 2002; 30(5): 989-96
Transesophageal echocardiography when performed by intensive care physicians is a safe procedure and provides useful information for the evaluation and management of critically ill patients.
Link
TEE Leads to Change in Management ▼
- Role of Transesophageal Echocardiography in Hemodynamically Unstable Patients
Sohn DW, Shin GJ, Oh JK, Tajik AJ, Click RL, Miller FA Jr, Seward JB
Mayo Clinic Proceedings, October 1995; 70(10):925-31
Authors conclude that transesophageal echocardiography can be safely performed in hemodynamically unstable patients, it produces a high diagnostic yield, and it provides important information for prompt therapeutic decision making. Therefore, we recommend transesophageal echocardiography as one of the initial diagnostic procedures in critically ill patients suspected of having an underlying cardiovascular disorder.
Link
- Intraoperative Transesophageal Echocardiography During Noncardiac Surgery
Suriani RJ, Neustein, S, Shore-Lesserson L, Konstadt S.
Journal of Vascular Anesthesia, June 1998; 12(3): 274-80
It appears that TEE in patients undergoing noncardiac surgery is efficacious in rapidly disclosing new findings and information during periods of hemodynamic instability. It may have a significant impact on intraoperative patient management and may be beneficial in patients older than 66 years of age.
Link
TEE and Intravascular Volume Status ▼
- Echocardiographic Measurement of Fluid Responsiveness
Cyril Charron, Vincent Caille, Francois Jardin and Antoine Viellard-Barron
Curr Opin Crit Care 12:249-54
Echocardiography has been widely demonstrated to predict fluid responsiveness accurately. This is now a complete and noninvasive tool able to accurately determine hemodynamic status in circulatory failure.
Link
Maxime Cannesson, Juliette Slieker, Olivier Desebbe, Fadi Farhat, Olivier Bastien and Jean-Jacques Lehot
Critical Care, Vol. 10, No. 6, 2006: pp R171 - R179
ΔSA by transoesophageal echocardiographic automated border detection is sensitive to changes in preload, can predict fluid responsiveness, and can quantify the effects of volume expansion on cardiac output. It has potential clinical applications.
- Echocardiographic and Hemodynamic Indexes of Left Ventricular Preload in Patients with Normal and Abnormal Ventricular Function
Albert T. Chueng, MD, Joseph S. Savino, MD, Stuart J. Weiss, MD, PhD, Stanley J. Aukburg, MD, Jesse A. Berlin, ScD
Anesthesiology, Vol. 81, 1994: pp 376-387
Link
- Assessment of Ventricular Function in Critically Ill Patients: Limitations of Pulmonary Artery Catheterization
Manuel L. Fontes, MD, Wayne Bellows, MD, Long Ngo, MS, and Dennis T. Mangano, PhD, MD
Journal of Cardiothoracic and Vascular Anesthesia, Vol. 113, No. 5 (October), 1999: pp 521-527
Authors report that both LV dysfunction and extremes of preload (hypovolemia or hypervolemia) are assessed poorly by clinicians using conventional clinical monitoring with pulmonary artery catheterization.
Link
- Transesophageal Echocardiography Values for Left Ventricular End-Diastolic Area and Pulmonary Vein and Mitral Inflow Doppler Velocities in Patients Undergoing Coronary Artery Bypass Graft Surgery
Colin Forbes Royse, MBBS, FANZCA, Michael John Barrington, MBBS, FANZCA, and Alistair George Royse, MBBS, FRACS
Journal of Cardiothoracic and Vascular Anesthesia, Vol. 14, No. 2 (April), 2000: pp 130-132
- The Use of Transesophageal Echocardiography for Preload Assessment in Critically Ill Patients
Claude P. Tousignant, MD, FRCPC, Fergus Walsh, MB, MRCPI, FFARCSI, and C. David Mazer, MD, FRCPC
Anesth Analg, Vol. 90, 2000: pp 351-355
This study provides evidence that the TEE gives information additive to the pulmonary artery catheter in the assessment of preload in an ICU population.
Link
- Comparison of Transesophageal Echocardiographic and Scintigraphic Estimates of Left Ventricular End-Diastolic Volume Index and Ejection Fraction in Patients Following Coronary Artery Bypass Grafting
John H. Urbanowicz, M.D., M. Jamil Shaaban, M.D., Neal H. Cohen, M.D., Michael K. Cahalan, M.D., Elias H. Botvinick, M.D., Kanu Chatterjee, M.B., F.R.C.P., Nelson B. Schiller, M.D., Michael W. Dae, M.D., Michael A. Matthay, M.D.
Anesthesiology, Vol. 7, 1990: pp 607-612
The authors conclude that immediately following CABG, a single cross-sectional TEE image provides a reasonable estimate of EF
Link
Echo and Fluid Responsiveness ▼
- Echocardiographic Measurement of Fluid Responsiveness
Cyril Charron, Vincent Caille, Francois Jardin and Antoine Vieillard-Baron
Current Opin Crit Care 12:249-254
Echocardiography has been widely demonstrated to predict fluid responsiveness accurately. This is now a complete and noninvasive tool able to accurately determine hemodynamic status in circulatory failure.
Link
TEE versus TTE ▼
- Hemodynamic Instability After Cardiac Surgery: Transesophageal Echocardiographic Diagnosis of a Localized Pericardial Tamponade
Fabio Sangalli, MD, Luisa Colagrande, MD, Bruna Manetti, MD, Leonello Avalli, MD’ Simona Celotti, MD, Paolo Maniglia, MD, Francesco Formica, MD, Giovanni Paolini, MD, PhD, and Antonio Presenti, MD, PhD
Journal of Cardiothoracic and Vascular Anesthesia, Vol. 19, No. 6 (December), 2005: pp775-776
"...TEE provides more accurate diagnoses in cardiac surgical patients.."
- Usefulness of Transesophageal Echocardiography in the Treatment of Critically Ill Patients
Hwang JJ, Shyu KG, Chen JJ, Tseng YZ, Kuan P, Lien WP
Chest, September 1993; 104(3):861-6
Transesophageal echocardiography was a safe, well-tolerated, and valuable diagnostic approach for the rapid detection of specific cardiac abnormalities in patients with critical illnesses; TEE should be considered in the treatment of critically ill patients especially when TEE provided inadequate information.
Link
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