FEASABILTY, UTILITY, AND SAFETY OF CRITICAL CARE TRANSESOPHAGEAL ECHOCARDIOGRAM PERFORMED IN A COMMUNITY HOSPITAL ICU

Abstract

TOPIC: Critical Care TYPE: Original Investigations PURPOSE: The Intensivist faces the challenging hemodynamics and complex heart-lung interaction in ventilated patients on daily basis. Critical care transesophageal echocardiogram (TEE) serves as another valuable diagnostic tool for the critical care provider when the transthoracic echocardiogram (TTE) fails to solve the hemodynamic dilemma, most likely because of inadequate window. We want to share our experience at a community hospital intensive care unit (ICU). Most importantly we examined the safety and feasibility of the procedure as well. METHODS: We retrospectively reviewed the charts, TEE reports and images of 16 patients in our ICU. We looked at the rationale behind doing a TEE, weather or not there was any clinically relevant finding from the TEE image acquisition and if that changed clinical management. RESULTS: TEE was feasible and safe in all 16 exams. There were no complications. The most common reason for the TEE was complex hemodynamics in the setting of poor TTE views. 4 exams were done to assess resuscitation during cardiac arrest and to identify any reversible or irreversible causes of the arrest. 1 exam was done to guide ECMO cannula insertion under direct visualization. 1 exam was done to examine the effect of a recruitment maneuver on the right ventricle (RV). We observed a clinically relevant finding in 14 exams. Subsequently these results were conveyed to the medical team taking care of the patient. As a result of the TEE report, a medical decision that changed current management by the primary team was done in 13 exams out of all 16. The most common treatment implemented based of the TEE report was the adjustment of the ventilator settings to improve RV function. Other important decisions included shock differentiation in a complex hemodynamic state, starting an inotrope and even changing LUCAS device position during CPR since initially it was observed via the TEE that the compressions were obstructing the left ventricle outlet (LVOT). CONCLUSIONS: In line with previous data, we found that critical care TEE is feasible, clinically useful and most importantly safely done by intensivists who received adequate training in advanced echocardiography. Our study shows that TEE is another valuable tool that intensivists in north America should be familiar with as it is the case in Europe. CLINICAL IMPLICATIONS: Critical Care TEE is a valuble tool that the intensivist can use to solve hemodynamic dilemmas. It is safe and feasible and has an attractive learning curve.We encourage critical care training programs to consider training their fellows in advanced echocardiography. In the Era of visual medicine, advanced critical care echocardiography is knocking on the doors. DISCLOSURES: No relevant relationships by Mohammad Arabiat, source=Web Response No relevant relationships by Karan Singh, source=Web Response