Impact of Critical Care Transesophageal Echocardiography in Medical–Surgical ICU Patients: Characteristics and Results From 274 Consecutive Examinations

2018 ◽  
Vol 35 (9) ◽  
pp. 896-902 ◽  
Author(s):  
Robert Arntfield ◽  
Vincent Lau ◽  
Yves Landry ◽  
Fran Priestap ◽  
Ian Ball
Keyword(s):  
Critical Care ◽  
Transesophageal Echocardiography ◽  
North American ◽  
Tertiary Care ◽  
Care Program ◽  
Hemodynamic Instability ◽  
Diagnostic Reliability ◽  
Icu Patients ◽  
Critical Care Echocardiography ◽  
Doppler Techniques

Objective: Critical care echocardiography has become an integral tool in the assessment and management of critically ill patients. Critical care transesophageal echocardiography (TEE) offers diagnostic reliability, superior image quality, and an expanded diagnostic scope to transthoracic echocardiography. Despite its favorable attributes, TEE use in North American intensive care units (ICUs) remains relatively undescribed. In this article, we seek to characterize the feasibility, indications, and clinical impact of a critical care TEE program. Design: Retrospective, observational study. Setting: Tertiary care, academic critical care program consisting of 2 hospitals in Ontario, Canada. Participants: Consecutive critical care TEE examinations on ICU patients performed between December 2012 and December 2016 Interventions: None. Measurements and Main Results: Consecutive critical care TEE studies on ICU patients from December 1, 2012, to December 31, 2016, were reviewed. The TEEs performed on cardiac surgery patients and those without reports were excluded. Examination details, including indications, complications, examination complexity (number of views, Doppler techniques), and clinical recommendations were aggregated and analyzed. Two hundred seventy-four TEE studies were performed by 38 operators. Common indications for TEE studies were hemodynamic instability (45.2%), assessment for infective endocarditis (22.2%), and cardiac arrest (20.1%). A change in patient management was proposed following 79.5% of TEE studies. Thirty-eight percent of TEE studies were performed during evening hours or on weekends. There were no mechanical complications. Conclusions: Our observational data support intensivist-performed TEE as being safe and therapeutically influential across a broad range of indications. Our program’s demonstrated feasibility and impact may act as a model for TEE adoption in other North American ICUs.

Transesophageal Echocardiography

2019 ◽  
pp. 816-826
Author(s):  
Ryan C. Craner ◽  
Farouk Mookadam ◽  
Harish Ramakrishna
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
North America ◽  
Transesophageal Echocardiography ◽  
Transthoracic Echocardiography ◽  
Tertiary Care ◽  
Specialized Training ◽  
Critical Care Echocardiography ◽  
Tertiary Care Centers

The use of ultrasound has revolutionized care in the intensive care unit (ICU). The use of critical care echocardiography, including transthoracic echocardiography (TTE), has become commonplace in ICUs worldwide. In North America, however, intensivists rarely perform transesophageal echocardiography (TEE) unless they have anesthesiology training or have received specialized training to be competent in TEE. In many centers, neurology critical care is provided within the general ICU, and many tertiary-care centers have a dedicated ICU for specialized cases that require advanced and intensive neurologic care.

scholarly journals Critical Care Echocardiography as a Routine Procedure for the Detection and Early Treatment of Cardiac Pathologies

Diagnostics ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. 671
Author(s):  
Stefan Schmidt ◽  
Jana-Katharina Dieks ◽  
Michael Quintel ◽  
Onnen Moerer
Keyword(s):  
Critical Care ◽  
Tertiary Care ◽  
Care Facility ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Icu Patients ◽  
Ventricular Ejection Fraction ◽  
Critical Care Echocardiography ◽  
Tertiary Care Facility ◽  
Significant Survival

Transthoracic and transesophageal echocardiography are important investigations in the intensive care unit (ICU) to diagnose acute cardiac pathologies and assess the haemodynamic status. Recommendations for critical care echocardiography (CCE) have been published recently, but these still lack an evidence-based foundation. It is not known if performing transthoracic echocardiography (TTE) on a routine basis instead of only when required in acute cases is feasible or clinically useful. In this single-centre prospective observational study, we routinely performed TTE on 111 consecutive non-cardiological, non-cardiothoracic surgical ICU patients in two surgical ICUs in a tertiary care facility. Significant cardiac pathologies were detected in 82 (76.6%) and critical cardiac pathologies in 33 (30.8%) of the 107 patients. The most common critical cardiac pathologies were sPAP > 50 mmHg (19.63%), tricuspid annular plane systolic excursion ≤ 13 mm (9.4%), grade III diastolic dysfunction (8.4%), severe tricuspid valve insufficiency (5.6%) and left ventricular ejection fraction (LV-EF) ˂ 30% (4.7%). Some of the most commonly found cardiac pathologies are not well emphasised in current recommendations and training programs. We observed a progression of the cardiac pathologies previously described in 41 of the patients (91.1%). Patients with echocardiographic abnormalities had a significant survival disadvantage in the ICU. By performing CCE routinely, we observed the range and prevalence of cardiac pathologies that can be detected by echocardiography in critically ill patients. We recommend routine transthoracic CCE in ICU patients for early detection of cardiac pathologies and to help inform early intervention regimens, since cardiac conditions carry a significant survival disadvantage for the ICU patient.

scholarly journals Quality improvement of delirium status communication and documentation for intensive care unit patients during daily multidisciplinary rounds

2018 ◽  
Vol 7 (2) ◽  
pp. e000239 ◽  
Author(s):  
Krishna Aparanji ◽  
Shreedhar Kulkarni ◽  
Megan Metzke ◽  
Yvonne Schmudde ◽  
Peter White ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Tertiary Care ◽  
Care Hospital ◽  
Icu Patients ◽  
Quality Metric ◽  
Risk Of Mortality ◽  
Simulation Based ◽  
Multidisciplinary Rounds

Delirium is a key quality metric identified by The Society of Critical Care Medicine for intensive care unit (ICU) patients. If not recognised early, delirium can lead to increased length of stay, hospital and societal costs, ventilator days and risk of mortality. Clinical practice guidelines recommend ICU patients be assessed for delirium at least once per shift. An initial audit at our urban tertiary care hospital in Illinois, USA determined that delirium assessments were only being performed 31% of the time. Nurses completed simulation based education and were trained using delirium screening videos. After the educational sessions, delirium documentation increased from 40% (12/30) to 69% (41/59) (two-proportion test, p<0.01) for dayshift nurses and from 27% (8/30) to 61% (36/59) (two-proportion test, p<0.01) during the nightshift. To further increase the frequency of delirium assessments, the delirium screening tool was standardised and a critical care progress note was implemented that included a section on delirium status, management strategy and discussion on rounds. After the documentation changes were implemented, delirium screening during dayshift increased to 93% (75/81) (two-proportion test, p<0.01). Prior to this project, physicians were not required to document delirium screening. After the standardised critical care note was implemented, documentation by physicians was 95% (106/111). Standardising delirium documentation, communication of delirium status on rounds, in addition to education, improved delirium screening compliance for ICU patients.

scholarly journals Staff Perceptions of the Barriers to Mobilizing ICU Patients

2015 ◽  
Author(s):  
Simone Dafoe ◽  
Kathy Stiller ◽  
Marianne Chapman
Keyword(s):  
Medical Condition ◽  
Tertiary Care ◽  
Hemodynamic Instability ◽  
Medical Procedure ◽  
Staff Perceptions ◽  
Icu Patients ◽  
Improvement Project ◽  
Prospective Survey ◽  
Resource Limitations ◽  
Level Of Consciousness

Purpose: Whilst early progressive mobilization is known to be safe and beneficial for patients in an intensive care unit (ICU), barriers still exist to its implementation. As part of a broader quality improvement project that had the overall aim of increasing the frequency of mobilization in our ICU, we conducted a survey of ICU staff to investigate their perceptions of the barriers to the early progressive mobilization of ICU patients. Method: A prospective survey of ICU staff in an Australian, tertiary care, public hospital ICU was undertaken. A total of 93 medical, nursing, and physiotherapy staff participated. A purpose-designed survey that investigated staff perceptions of the barriers to the early progressive mobilization of ICU patients was developed. The survey predominantly comprised closed statements requiring responses using a visual analogue scale. Barriers to early progressive mobilization were separated into three sections: patient-related, institutional-related, and other barriers. Results: Patient-related barriers were generally perceived as having the greatest influence on the mobilization of ICU patients, followed closely by institutional-related barriers. The factors that were perceived as most frequently preventing mobilization were hemodynamic instability, reduced level of consciousness, sedation, agitation, impending medical procedure, staff availability, and time constraints. Conclusions: ICU staff perceived that barriers to the early progressive mobilization of ICU patients were multifactorial and most frequently involved patients’ medical condition and resource limitations.

Diagnostic Accuracy of Critical Care Transesophageal Echocardiography vs Cardiology-Led Echocardiography in ICU Patients

CHEST Journal ◽  
2019 ◽  
Vol 155 (3) ◽  
pp. 491-501 ◽  
Author(s):  
Vincent Lau ◽  
Fran Priestap ◽  
Yves Landry ◽  
Ian Ball ◽  
Robert Arntfield
Keyword(s):  
Critical Care ◽  
Diagnostic Accuracy ◽  
Transesophageal Echocardiography ◽  
Icu Patients

scholarly journals Iatrogenic anaemia and transfusion thresholds in ICU patients with COVID-19 disease at a tertiary care hospital

2021 ◽  
pp. 103068
Author(s):  
Ivo Beverina ◽  
Erika Borotto ◽  
Chiara Novelli ◽  
Danilo Radrizzani ◽  
Bruno Brando
Keyword(s):  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Hospital ◽  
Icu Patients

scholarly journals Daily Bathing with Chlorhexidine-Based Soap and the Prevention of Staphylococcus aureus Transmission and Infection

2014 ◽  
Vol 35 (3) ◽  
pp. 243-250 ◽  
Author(s):  
Melissa A. Viray ◽  
James C. Morley ◽  
Craig M. Coopersmith ◽  
Marin H. Kollef ◽  
Victoria J. Fraser ◽  
...  
Keyword(s):  
At Risk ◽  
Staphylococcus Aureus ◽  
Tertiary Care ◽  
Control Unit ◽  
Post Intervention ◽  
Icu Patients ◽  
Chlorhexidine Bathing ◽  
Before And After ◽  
Surgical Icu ◽  
Time Series Methodology

Objective.Determine whether daily bathing with chlorhexidine-based soap decreased methicillin-resistant Staphylococcus aureus (MRSA) transmission and intensive care unit (ICU)-acquired S. aureus infection among ICU patients.Design.Prospective pre-post-intervention study with control unit.Setting.A 1,250-bed tertiary care teaching hospital.Patients.Medical and surgical ICU patients.Methods.Active surveillance for MRSA colonization was performed in both ICUs. In June 2005, a chlorhexidine bathing protocol was implemented in the surgical ICU. Changes in S. aureus transmission and infection rate before and after implementation were analyzed using time-series methodology.Results.The intervention unit had a 20.68% decrease in MRSA acquisition after institution of the bathing protocol (12.64 cases per 1,000 patient-days at risk before the intervention vs 10.03 cases per 1,000 patient-days at risk after the intervention; β, −2.62 [95% confidence interval (CI), −5.19 to −0.04]; P = .046). There was no significant change in MRSA acquisition in the control ICU during the study period (10.97 cases per 1,000 patient-days at risk before June 2005 vs 11.33 cases per 1,000 patient-days at risk after June 2005; β, −11.10 [95% CI, −37.40 to 15.19]; P = .40). There was a 20.77% decrease in all S. aureus (including MRSA) acquisition in the intervention ICU from 2002 through 2007 (19.73 cases per 1,000 patient-days at risk before the intervention to 15.63 cases per 1,000 patient-days at risk after the intervention [95% CI, −7.25 to −0.95]; P = .012)]. The incidence of ICU-acquired MRSA infections decreased by 41.37% in the intervention ICU (1.96 infections per 1,000 patient-days at risk before the intervention vs 1.15 infections per 1,000 patient-days at risk after the intervention; P = .001).Conclusions.Institution of daily chlorhexidine bathing in an ICU resulted in a decrease in the transmission of S. aureus, including MRSA. These data support the use of routine daily chlorhexidine baths to decrease rates of S. aureus transmission and infection.

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