Chest
Volume 107, Issue 3, March 1995, Pages 774-779
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Clinical Investigations in Critical Care: Articles
Evaluation of Transesophageal Echocardiography as a Diagnostic and Therapeutic Aid in a Critical Care Setting

https://doi.org/10.1378/chest.107.3.774Get rights and content

Objectives

To assess the impact of transesophageal echocardiography (TEE) on therapeutic management in relation to pulmonary artery catheterization (PAC) in the ICU.

Design

Retrospective analysis of 108 consecutive TEE video and related patient files during a 7-month period.

Setting

A 33-bed medical and surgical ICU.

Methods

All critically ill patients with or without PAC in whom a TEE was performed, excluding postoperative cardiac surgical patients. Patients were divided in a cardiac and a septic group depending on the primary disease on admission to the ICU. The impact of TEE in relation to PAC on ICU management was evaluated in whether therapy changes were performed strictly on the basis of the TEE findings.

Main results

Of 64% of patients with a PAC, 44% underwent therapy changes after TEE: 41% in the cardiac and 54% in the septic subgroup. In 41% of patients without a PAC, TEE led to a change in therapy.

Conclusions

TEE results in altered therapeutic management in at least one third of our (noncardiac surgery) ICU patient population independent of the presence of a PAC.

Section snippets

Patient Selection

All critically ill patients in a 33-bed ICU who underwent a TEE during a 7-month period between January and July 1991 were included. Excluded were patients after cardiac surgery. The patient population was assorted into patients who did and who did not have a PAC at the time of the TEE. Moreover, in the two groups, three subgroups were made depending on the primary disease on admission to the ICU. When cardiac disease was the foremost indication of admittance, patients were assorted within a

Patient Characteristics and Subgroup Identification

Of 982 patients admitted to the ICU during the study period, 108 patients underwent a TEE (Table 1). The mean age was 62 years (range, 8 to 83 years; 32 women, 76 men). Sixty patients (56%) were ventilated at the time of the TEE.

The cardiac subgroup consisted of 63 patients and the septic group consisted of 37 patients. In a third subgroup (n=3) the primary indication was assessment of extracardiac abnormalities. Five patients with mixed abnormalities could not be asserted in either the septic

Discussion

The clinical application of TEE has been studied in many conditions1, 2, 3, 4,8 and gradually this technique has been validated in the critical care setting. Some studies claim the importance of TEE in the postoperative follow-up after cardiac surgery.9, 10 In the noncardiac surgery ICU, several authors have shown the additional value of TEE in decision making.11, 12, 13, 14, 15, 16 We particularly studied the potential role of TEE in the ICU in patients instrumented with a PAC concerning

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