Hemodynamic assessment of ventilated ICU patients with cardiorespiratory failure using a miniaturized multiplane transesophageal echocardiography probe
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To assess the feasibility, image quality, diagnostic accuracy, therapeutic impact and tolerance of diagnostic and hemodynamic assessment using a novel miniaturized multiplane transesophageal echocardiography (TEE) probe in ventilated ICU patients with cardiopulmonary compromise.
Prospective, descriptive, single-center study.
Fifty-seven ventilated patients with acute circulatory or respiratory failure were assessed, using a miniaturized multiplane TEE probe and a standard TEE probe used as reference, randomly by two independent experienced operators. Measurements of hemodynamic parameters were independently performed off-line by a third expert. Diagnostic groups of acute circulatory failure (n = 5) and of acute respiratory failure (n = 3) were distinguished. Hemodynamic monitoring was performed in 9 patients using the miniaturized TEE probe. TEE tolerance and therapeutic impact were reported.
The miniaturized TEE probe was easier to insert than the standard TEE probe. Despite lower imaging quality of the miniaturized TEE probe, the two probes had excellent diagnostic agreement in patients with acute circulatory failure (Kappa: 0.95; 95 % CI: 0.85–1) and with acute respiratory failure (Kappa: 1; 95 % CI: 1.0–1.0). Accordingly, therapeutic strategies derived from both TEE examinations were concordant (Kappa: 0.82; 95 % CI: 0.66–0.97). The concordance between quantitative hemodynamic parameters obtained with both TEE probes was also excellent. No relevant complication secondary to TEE probes insertion occurred.
Hemodynamic assessment of ventilated ICU patients with cardiopulmonary compromise using a miniaturized multiplane TEE probe appears feasible, well-tolerated, and relevant in terms of diagnostic information and potential therapeutic impact. Further larger-scale studies are needed to confirm these preliminary results.
KeywordsEchocardiography Critical care echocardiography Transesophageal echocardiography Hemodynamic monitoring
PV takes responsibility for the content of the manuscript, including the data and analysis. EB and PV: designed the study; acquired and interpreted the data; drafted and revised the manuscript. CE, MC, NP, BF: acquired the data; revised the manuscript. FD and RL: interpreted the data; revised the manuscript. All authors approved the final version of the manuscript.
Compliance with ethical standards
Conflicts of interest
The miniaturized multiplane probe was lent by Philips Healthcare, which was not involved in data acquisition and analysis and did not take part in the manuscript drafting.
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