scholarly journals Comparison of flow-independent parameters for grading severity of aortic stenosis using intraoperative transesophageal echocardiography – A prospective observational study

2020 ◽  
Vol 23 (4) ◽  
pp. 425
Author(s):  
Vishwas Malik ◽  
S Nanditha
Keyword(s):  
Aortic Stenosis ◽  
Observational Study ◽  
Transesophageal Echocardiography ◽  
Prospective Observational Study ◽  
Intraoperative Transesophageal Echocardiography ◽  
Independent Parameters

scholarly journals Learning Curve for the Acquisition of 20 Standard Two-Dimensional Images in Advanced Perioperative Transesophageal Echocardiography: A Prospective Observational Study

2021 ◽  
Author(s):  
Prasert Sawasdiwipachai ◽  
Sasithorn Thanasriphakdeekul ◽  
Vithaya Chithiraphan ◽  
Kasana Raksamani ◽  
Kamheang Vacharaksa
Keyword(s):  
Observational Study ◽  
Learning Curve ◽  
Transesophageal Echocardiography ◽  
Success Rate ◽  
Prospective Observational Study ◽  
Two Dimensional ◽  
Trainee Group ◽  
Short Course ◽  
Thoracic Anesthesia ◽  
Intraoperative Transesophageal Echocardiography

Abstract Background Learning to perform intraoperative transesophageal echocardiography takes time and practice. We aimed to determine the cumulative success rate in the first 20 intraoperative transesophageal echocardiography cases performed by trainee anesthesiologists with no transesophageal echocardiography experience. Methods This prospective observational study included nine anesthesiologists (four cardiovascular and thoracic anesthesia fellows and five short-course perioperative intraoperative transesophageal echocardiography trainees). Overall, 180 studies self-performed by the trainees were reviewed by certified reviewers. A study was considered successful when at least 15 qualified images were collected within 30 minutes. The cumulative success of each trainee was used as a surrogate of a basic two-dimensional intraoperative transesophageal echocardiography learning curve. Results The participants comprised three male and six female anesthesiologists aged 29–43 years with 2–13 years of work experience. Most studies (146/180, 81.11%) were completed within 30 minutes, and the cumulative success rate was 70–90% (average 82.78 ± 6.71%). The average cumulative success rate in the short-course group (85 ± 7.07%) was higher than that in the official cardiovascular and thoracic fellow trainee group (80 ± 7.07%). The recommended caseload for a 75–80% success rate was 14–18 cases (95% confidence interval, 0.675–0.969). Conclusions We recommended a 14–18 caseload for a target success rate of 75–80% in studies performed by trainees with no previous experience. Our findings will enable the development of programs to train anesthesiologists in intraoperative transesophageal echocardiography.

scholarly journals Transesophageal echocardiography-associated tracheal microaspiration and ventilator-associated pneumonia in intubated critically ill patients: a multicenter prospective observational study

Critical Care ◽  
2020 ◽  
Vol 24 (1) ◽  
Author(s):  
François Bagate ◽  
Anahita Rouzé ◽  
Farid Zerimech ◽  
Florence Boissier ◽  
Vincent Labbe ◽  
...  
Keyword(s):  
Observational Study ◽  
Transesophageal Echocardiography ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Prospective Observational Study ◽  
Cuff Pressure ◽  
Ventilator Associated Pneumonia ◽  
Salivary Amylase ◽  
Before And After ◽  
Tracheal Cuff

Abstract Background Microaspiration of gastric and oropharyngeal secretions is the main causative mechanism of ventilator-associated pneumonia (VAP). Transesophageal echocardiography (TEE) is a routine investigation tool in intensive care unit and could enhance microaspiration. This study aimed at evaluating the impact of TEE on microaspiration and VAP in intubated critically ill adult patients. Methods It is a four-center prospective observational study. Microaspiration biomarkers (pepsin and salivary amylase) concentrations were quantitatively measured on tracheal aspirates drawn before and after TEE. The primary endpoint was the percentage of patients with TEE-associated microaspiration, defined as: (1) ≥ 50% increase in biomarker concentration between pre-TEE and post-TEE samples, and (2) a significant post-TEE biomarker concentration (> 200 μg/L for pepsin and/or > 1685 IU/L for salivary amylase). Secondary endpoints included the development of VAP within three days after TEE and the evolution of tracheal cuff pressure throughout TEE. Results We enrolled 100 patients (35 females), with a median age of 64 (53–72) years. Of the 74 patients analyzed for biomarkers, 17 (23%) got TEE-associated microaspiration. However, overall, pepsin and salivary amylase levels were not significantly different between before and after TEE, with wide interindividual variability. VAP occurred in 19 patients (19%) within 3 days following TEE. VAP patients had a larger tracheal tube size and endured more attempts of TEE probe introduction than their counterparts but showed similar aspiration biomarker concentrations. TEE induced an increase in tracheal cuff pressure, especially during insertion and removal of the probe. Conclusions We could not find any association between TEE-associated microaspiration and the development of VAP during the three days following TEE in intubated critically ill patients. However, our study cannot formally rule out a role for TEE because of the high rate of VAP observed after TEE and the limitations of our methods.

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