1025-97 Therapeutic Implications of the Use of Transesophageal Echocardiography in I.C.U. Patients with Unexplained Hypoxemia

Abstract

The aim of this prospective study was to evaluate the diagnostic and therapeutic implications of transesophageal echocardiography (TEEI in critically ill patients with unexplained hypoxemia hospitalized in a general ICU. Between January 1st, 1992 and May 31 st. 1993, transthoracic (TIE) and TEE were performed in 31 patients (mean age: 61 ± 14, Apache II Score: 20 ± 7, mechanical ventilation: 74 p.cent) with severe (PaO2/FiO2 < 200) and unexplained hypoxemia. The results of each TEE examination were compared with the clinical and TIE data. The following classification was used: class 00 = the TEE results disabled TIE diagnosis; class 0 = the TEE results were similar to TIE results; class 1 = the TEE results revealed a new but minor finding; class 2 = the TEE results revealed a new and major finding without therapeutic consequences; class 3 = the TEE resulted in immediate therapeutic modifications. All TEE data were reviewed by 2 different intensive care staff members. In case of disagreement the results were discussed until a consensus was reached. class 0 = 16 patients (52 p.cent). class 00 = 1 patient (3 p.cent), class 1: 4 patients (13 p.cent), class 2 = 4 patients (13 p.cent), class 3 = 6 patients 119 p.cent). In these last 10 patients (32 p.cent), TEE findings were judged significant: three atrial septal defect and one patent foramen ovale (two of them were ventilated with PEEP and were rapidly weaned, and one was breathing spontaneously!; two mitral regurgitations requiring surgery, one important mitral vegetation (requiring administration of antimicrobial therapy) and three left atrial thrombus (requiring new antithrombotic therapy in one case). Our results suggest that TEE is an important advance in the therapeutic management of hypoxemia in critically ill patients.