Initial clinical experience with a miniaturized transesophageal echocardiography probe in a cardiac intensive care unit.

OBJECTIVE

To investigate the safety of a novel, miniaturized, monoplane transesophageal echocardiography probe (mTEE) and its potential as a hemodynamic monitoring tool.

DESIGN

This was a retrospective analysis of the clinical evaluation of a disposable mTEE in ventilated patients with severe cardiogenic shock requiring hemodynamic support. mTEE assessment was performed by operators with mixed levels of TEE training. Information on hemodynamic interventions based on mTEE findings was recorded.

SETTING

A tertiary university cardiac critical care unit.

PARTICIPANTS

Male and female critical care patients admitted to the unit with severe hemodynamic instability.

INTERVENTIONS

Insertion of miniaturized disposable TEE probe and hemodynamic and other critical care interventions based on this and conventional monitoring.

MEASUREMENTS AND MAIN RESULTS

In 41 patients (51.2% female, 73.2% after cardiac surgery), hemodynamic support probe insertion was accomplished without major complications. A total of 195 mTEE studies were performed, resulting in changes in therapy in 37 (90.2%) patients based on mTEE findings, leading to an improvement in hemodynamic parameters in 33 (80.5%) patients. Right ventricular (RV) failure was diagnosed in 25 patients (67.6%) and mTEE had a direct therapeutic impact on management of RV failure in 17 patients (68 %).

CONCLUSIONS

Insertion and operation of a novel, miniaturized transoesophageal echocardiography probe can be performed for up to 72 hours without major complications. Repeated assessment using this device provides complementary information to invasive monitoring in the majority of patients and has an impact on hemodynamic management.