Cardiothoracic Surgery |

Feasibility of Introduction of Minaturized Transesophageal Echocardiography (hTEE) Into a Cardiac Surgery Intensive Care Unit and Analysis of Its Clinical Impact FREE TO VIEW

Jason Vourlekis, MD; Osman Malik, MD; Ramesh Singh, MD; Nitin Puri, MD; Megan Terek, MD; Ashok Cattamanchi, MD; Chris King, MD
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Inova Fairfax, Washington, DC

Chest. 2015;148(4_MeetingAbstracts):31A. doi:10.1378/chest.2275046
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SESSION TITLE: Cardiothoracic Surgery Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: To describe introduction of hTEE into a tertiary care Cardiac Surgery Intensive Care Unit (CSICU) and define the clinical impact on critically-ill patients.

METHODS: Case series of 38 cardiac surgery patients who received hTEE imaging performed by multiple providers, including Medical Intensivists, Physician Assistants and Cardiac Surgeons. Each received standardized training by cardiac sonographers, including simulation, image interpretation and image acquisition on live patients. Guidelines for usage were developed, but individual providers determined actual use. The hTEE probes can remain indwelling for 72 hours allowing multiple imaging sessions. The three images that can be obtained are Mid-Esophageal Super Vena Cava View, the 4 chamber view and the Transgastric Short Axis. The clinical findings and therapeutic decisions for each case were recorded in a secure database.

RESULTS: In 27/38 patients all three imaging planes were obtained. In 37/38 patients clinically useful information was obtained. Hemodynamic management categorized as alteration in intravascular fluid given 15/38 patients, vasopressor or inotrope titration in 15/38 patients, inhaled Nitric Oxide titration occurred in 4/5 patients. 2/38 patients did not require an after hours or weekend echocardiography to be done. 2/38 patients did not have to go back to the operating room for re-exploration. 2/38 patients had minor bleeding from probe placement, but did not require blood transfusions.

CONCLUSIONS: The hTEE probe can successfully be introduced into a tertiary-care CSICU with multidisciplinary providers. HTEE impacted the management of 26/38 patients with minor risk to them. The hTEE probe can save the need for emergency re-exploration and the need for after hours echocardiography in this population. Further review is necessary to see if these changes impact patient length of stay, ventilator weaning and or mortality.

CLINICAL IMPLICATIONS: Htee can be introduced successfully with standardized training to multidisciplinary providers who have no formalized training in echocardiography. The technology is safe and can reduce the need for emergency post-operative echocardiograms, unnecessary reexplorations and decrease the duration of use of inhaled vasodilators. It is an alternative way to assess hemodynamics and cardiac function in critically-ill patients.

DISCLOSURE: The following authors have nothing to disclose: Jason Vourlekis, Osman Malik, Ramesh Singh, Nitin Puri, Megan Terek, Ashok Cattamanchi, Chris King

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