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Diagnostic and therapeutic implications of transesophageal echocardiography in medical ICU patients with unexplained shock, hypoxemia, or suspected endocarditis

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Abstract

Objective

To evaluate the diagnostic and therapeutic implications of transesophageal echocardiography (TEE) in intensive care patients.

Design

Comparative study.

Setting

A 10-bed general intensive care unit.

Patients

Between 1 January 1992 and 31 May 1993, 61 patients prospectively identified with shock (n=14), severe, unexplained hypoxemia (Partial pressure of oxygen in arterial blood/fractional inspired oxygen <200) (n=31), or suspected endocarditis (n=16) underwent a TEE examination to supplement transthoracic echocardiography (TTE) examination.

Interventions

The results of each TEE examination were compared with the clinical findings and TTE data. TEE examinations were classified as follows: 0, TEE results were similar to TTE results; 00, TEE examination resulted in exclusion of suspected abnormalities; 1, TEE revealed a new but minor diagnosis compared to the TTE diagnosis; 2, TEE revealed a new major diagnosis not requiring a change of treatment; 3, TEE results revealed a new major diagnosis requiring an immediate change of treatment.

Results

Intraobserver reliability of the TEE classification was confirmed by a 100% concordance and interobserver reliability was evaluated as an 84% concordance. Results of the TEE classification were: class 0,n=21 (34%); class 00,n=13 (21%); class 1,n=7 (12%); class 2,n=8 (13%); class 3,n=12 (20%). Therapeutic implications of TEE in class 3 patients were cardiac surgery in 5 patients (2 cases of acute mitral regurgitation, 2 valvular abscesses, and 1 hematoma compressing the left atrium), discontinuation of positive end-expiratory pressure in 1 ventilated patient with an atrial septal defect, weaning off mechanical ventilation in 1 patient with an atrial septal defect, prescription of antimicrobial therapy in 3 patients with endocarditis, and prescription of anticoagulant therapy in 2 patients with left atrial thrombus. No difficulty inserting the transducer was observed in any of the 61 patients studied. The only noteworthy complication was a case of spontaneously resolving atrial fibrillation.

Conclusion

TEE is safe and well tolerated and is useful in the management of patients in the intensive care unit with shock, unexplained and severe hypoxemia, or suspected endocarditis when TTE is inconclusive.

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Authors and Affiliations

  1. Service de Réanimation Polyvalente, Hôpital Nord, F-80054, Amiens Cedex, France

    M. A. Slama & M. Ossart

  2. Service de Réanimation Médicale, Hôpital Broussais, Paris, France

    A. Novara, A. Safavian, M. Safar & J. Y. Fagon

  3. Département d'Anesthésie et Réanimation, Hôpital Saint Jean, Brugges, Belgique

    P. Van De Putte

  4. Département de Cardiologie, Hôpital Broussais, Paris, France

    B. Diebold

Authors
  1. M. A. Slama
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  2. A. Novara
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  3. P. Van De Putte
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  4. B. Diebold
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  5. A. Safavian
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  6. M. Safar
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  7. M. Ossart
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  8. J. Y. Fagon
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Additional information

This work was presented in part at the 8th European Congress of Intensive Care Medicine, Athens, Greece, October 1995.

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Slama, M.A., Novara, A., Van De Putte, P. et al. Diagnostic and therapeutic implications of transesophageal echocardiography in medical ICU patients with unexplained shock, hypoxemia, or suspected endocarditis. Intensive Care Med 22, 916–922 (1996). https://doi.org/10.1007/BF02044116

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  • DOI: https://doi.org/10.1007/BF02044116

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