Wray Trenton C, Johnson Molly, Cluff Shelby, Nguyen Fiona T, Tawil Isaac, Braude Darren, Hanna Wendy, Azevedo Keith, Venkataramani Ranjani, Dettmer Todd S, Marinaro Jonathan
12289University of New Mexico Health Sciences Center, Albuquerque, NM, USA.
12288University of New Mexico, Albuquerque, NM, USA.
J Intensive Care Med. 2022 Jul;37(7):917-924. doi: 10.1177/08850666211042522. Epub 2021 Sep 20.
Data on the use of transesophageal echocardiography (TEE) by intensivist physicians (IP) and emergency physicians (EP) are limited. This study aims to characterize the use of TEE by IPs and EPs in critically ill patients at a single center in the United States. Retrospective chart review of all critical care TEEs performed from January 1, 2016 to January 31, 2021. The personnel performing the exams, location of the exams, characteristics of exams, complications, and outcome of the patients were reviewed. A total of 396 examinations was reviewed. TEE was performed by IPs (92%) and EPs (9%). The location of TEE included: intensive care unit (87%), emergency department (11%), and prehospital (2%) settings. The most common indications for TEE were: hemodynamic instability/shock (44%), cardiac arrest (23%), and extracorporeal membrane oxygenation (ECMO) facilitation, adjustment, or weaning (21%). The most common diagnosis based on TEE were: normal TEE (25%), left ventricular dysfunction (19%), and vasodilatory shock (15%). A management change resulted from 89% of exams performed. Complications occurred in 2% of critical care TEEs. TEE can be successfully performed by IPs and EPs on critically ill patients in multiple clinical settings. TEE frequently informed management changes with few complications.
关于重症医学科医生(IP)和急诊科医生(EP)使用经食管超声心动图(TEE)的数据有限。本研究旨在描述美国一家单一中心的IP和EP在危重症患者中使用TEE的情况。对2016年1月1日至2021年1月31日期间进行的所有重症监护TEE检查进行回顾性病历审查。审查了进行检查的人员、检查地点、检查特征、并发症以及患者的结局。共审查了396项检查。TEE由IP(92%)和EP(9%)进行。TEE的检查地点包括:重症监护病房(87%)、急诊科(11%)和院前(2%)环境。TEE最常见的适应证为:血流动力学不稳定/休克(44%)、心脏骤停(23%)以及体外膜肺氧合(ECMO)辅助、调整或撤机(21%)。基于TEE最常见的诊断为:TEE正常(25%)、左心室功能障碍(19%)和血管扩张性休克(15%)。89%的检查导致了管理上的改变。2%的重症监护TEE检查出现了并发症。IP和EP能够在多种临床环境中成功地对危重症患者进行TEE检查。TEE经常为管理改变提供依据,且并发症较少。