Department of Anesthesiology, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA.
Department of Anesthesiology, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA.
J Cardiothorac Vasc Anesth. 2020 Jul;34(7):1824-1832. doi: 10.1053/j.jvca.2020.01.028. Epub 2020 Jan 22.
The value of a simplified, focused intraoperative transesophageal echocardiography (TEE) protocol in patients undergoing liver transplantation (LT) is unknown. We sought to create and assess a 5-view LT TEE examination focused on 5 prespecified common causes of hypotension during LT.
Retrospective cohort study.
Single-center tertiary academic hospital.
All patients undergoing LT with TEE from January 2010 through May 2019.
None.
A 5-view LT TEE protocol adapted from a published rescue TEE protocol was assessed retrospectively in a cohort of 106 patients. The primary outcome was the frequency with which the protocol would have detected a composite of 5 prespecified causes of hypotension if the TEE exam had been limited to those views. To assess potential influence on intraoperative care, management changes associated with TEE images were extracted from the medical record. The prespecified diagnoses occurred 24 times; the LT TEE protocol would have detected 22 of 24 of these (92%, 95% confidence interval [CI]: 74%-98%). Intraoperative management changes occurred in 15 of 16 patients (94%) with 1 of the prespecified TEE findings, compared with 1 of 27 patients (3.7%) with TEE findings outside those diagnoses (p < 0.0001).
In a retrospective cohort study, a simplified LT TEE protocol would have detected 92% of prespecified TEE findings. Management changes occurred in 94% of those patients, while changes rarely occurred in patients with other TEE findings. A focused LT TEE protocol may diagnose critical pathology adequately and guide management during LT when standard monitors are insufficient.
简化、重点突出的经食管超声心动图（TEE）方案在肝移植（LT）患者中的应用价值尚不清楚。我们旨在创建并评估一种 5 视图 LT TEE 检查，重点关注 LT 期间低血压的 5 种常见原因。
回顾性队列研究。
单中心三级学术医院。
2010 年 1 月至 2019 年 5 月期间所有接受 LT 并进行 TEE 的患者。
无。
从发表的抢救 TEE 方案中改编的 5 视图 LT TEE 方案在 106 例患者的队列中进行了回顾性评估。主要结果是，如果 TEE 检查仅限于这些视图，该方案检测到 5 种特定低血压原因的复合频率。为了评估其对术中护理的潜在影响，从病历中提取与 TEE 图像相关的管理变化。指定的诊断发生了 24 次；LT TEE 方案将检测到 24 次中的 22 次（92%，95%置信区间[CI]：74%-98%）。16 例患者中有 15 例（94%）的术中管理发生了变化，其中 1 例存在 TEE 发现，而 27 例患者中有 1 例（3.7%）的 TEE 发现不在这些诊断范围内（p<0.0001）。
在回顾性队列研究中，简化的 LT TEE 方案将检测到 92%的指定 TEE 发现。94%的患者发生了管理变化，而在其他 TEE 发现的患者中很少发生变化。当标准监测不足时，重点突出的 LT TEE 方案可能能够充分诊断关键病理，并在 LT 期间指导管理。
