Subscribe to RSS
DOI: 10.1055/s-2007-963283
© Georg Thieme Verlag KG Stuttgart · New York
Handheld vs. Conventional Transesophageal Echocardiography in Non-Cardiac Surgical Intensive Care Unit Patients
Transösophageale Echokardiografie mittels miniaturisiertem Ultraschallsystem bei operativen IntensivpatientenPublication History
received: 28.6.2006
accepted: 24.5.2007
Publication Date:
03 August 2007 (online)
![](https://www.thieme-connect.de/media/ultraschall/200805/lookinside/thumbnails/10.1055-s-2007-963283-1.jpg)
Ziel: Wir untersuchten die Anwendbarkeit eines miniaturisierten Ultraschallsystems für die transösophageale Echokardiografie (TEE). Material und Methoden: 18 tief sedierte, nichtherzchirurgische operative Intensivpatienten wurden prospektiv in die Untersuchung eingeschlossen. Die Bildqualität und die mit dem miniaturisierten Ultraschallsystem erhobenen Diagnosen wurden mit einem Standard-TEE-System verglichen. Alle Patienten wurden von unabhängigen Untersuchern randomisiert mit beiden Systemen untersucht; dabei wurde einem festgelegten Untersuchungsgang gefolgt. Die Bildqualität der zweidimensionalen Darstellung der kardialen Standardschnittebenen und der Spektraldoppleruntersuchungen wurden auf einer visuellen Analogskala bewertet. Es erfolgte eine Dokumentation der Untersuchungszeiten. Ergebnisse: In der zweidimensionalen Darstellung der Standardschnittebenen konnten keine Unterschiede zwischen den zwei Systemen detektiert werden. Bei einigen Spektraldopplerdarstellungen war das Standardsystem dem miniaturisierten System überlegen. Schlussfolgerung: Die bettseitige Akutdiagnostik eines hämodynamisch instabilen Intensivpatienten ist mit einem miniaturisierten TEE-System hinreichend aussagekräftig.
Purpose: We examined the feasibility of a newly developed handheld ultrasound device capable of transesophageal echocardiography (TEE). Materials and Methods: Prospective case series in a non-cardiac surgical intensive care unit including 18 deeply sedated and endotracheally intubated critically ill non-cardiac surgical patients. The imaging quality and findings of a newly developed handheld device were compared to those of a cart-based standard TEE system. All patients were examined with both systems in a randomized order by independent examiners performing a structured and complete TEE examination. The imaging quality of the standard cardiac cross sections and spectral Doppler studies of the cardiac valves was assessed on an analog scale from 1 (excellent) to 5 (insufficient). The time requirements for each study were documented. Results: We did not detect significant differences in two-dimensional imaging. Continuous-wave Doppler imaging of the left ventricular outflow tract and pulsed-wave Doppler imaging of the transmitral flow were significantly better (p < 0.001) with the standard system. Conclusion: Handheld TEE is a goal-oriented diagnostic tool, which may sufficiently replace a standard cart-based TEE system in unstable critically ill patients when an acute gross diagnosis is required.
Key words
heart - echocardiography - anesthesia
References
- 1 Hodgins L, Kisslo J A, Mark J B. Perioperative transesophageal echocardiography: the anesthesiologist as cardiac diagnostician. Anesth Analg. 1995; 80 4-6
- 2 Oh J K, Seward J B, Khandheria B K. et al . Transesophageal echocardiography in critically ill patients. Am J Cardiol. 1990; 66 1492-1495
- 3 Poelaert J I, Trouerbach J, De Buyzere M. et al . Evaluation of transesophageal echocardiography as a diagnostic and therapeutic aid in a critical care setting. Chest. 1995; 107 774-779
- 4 Thys D, Abel M, Bollem B. et al . Practice guidelines for perioperative transesophageal echocardiography. A report by the American Society of Anesthesiologists and the Society of Cardiovascular Anesthesiologists Task Force on Transesophageal Echocardiography. Anesthesiology. 1996; 84 986-1006
- 5 Giannotti G, Mondillo S, Galderisi M. et al . Hand-held echocardiography: added value in clinical cardiological assessment. Cardiovasc Ultrasound. 2005; 3 7
- 6 Gorcsan J. Utility of hand-carried ultrasound for consultative cardiology. Echocardiography. 2003; 20 463-469
- 7 Marhofer P, Greher M, Kapral S. Ultrasound guidance in regional anaesthesia. Br J Anaesth. 2005; 94 7-17
- 8 Milling T J, Rose Jr J, Briggs W M. et al . Randomized, controlled clinical trial of point-of-care limited ultrasonography assistance of central venous cannulation: the Third Sonography Outcomes Assessment Program (SOAP-3) Trial. Crit Care Med. 2005; 33 1764-1769
- 9 Leta R, Carreras F, Borras X. et al . Usefulness of hand-held echocardiography in emergency room. Med Clin (Barc). 2003; 121 178-180
- 10 Shanewise J S, Cheung A T, Aronson S. et al . ASE/SCA guidelines for performing a comprehensive intraoperative multiplane transesophageal echocardiography examination: recommendations of the American Society of Echocardiography Council for Intraoperative Echocardiography and the Society of Cardiovascular Anesthesiologists Task Force for Certification in Perioperative Transesophageal Echocardiography. Anesth Analg. 1999; 89 870-884
- 11 Vignon P. Portable echocardiographs: useful or futile?. Arch Mal Coeur Vaiss. 2003; 96 1202-1209
Dr. med. Joerg Brederlau
Klinik und Poliklinik für Anästhesiologie, Universitätsklinikum Würzburg
Oberdürrbacher Str. 6
97080 Würzburg
Phone: ++49/9 31/20 13 04 10
Fax: ++49/9 31/20 13 04 19
Email: brederlau_j@klinik.uni-wuerzburg.de