Handheld vs. Conventional Transesophageal Echocardiography in Non-Cardiac Surgical Intensive Care Unit Patients

Ziel: Wir untersuchten die Anwendbarkeit eines miniaturisierten Ultraschallsystems für die transösophageale Echokardiografie (TEE). Material und Methoden: 18 tief sedierte, nichtherzchirurgische operative Intensivpatienten wurden prospektiv in die Untersuchung eingeschlossen. Die Bildqualität und die mit dem miniaturisierten Ultraschallsystem erhobenen Diagnosen wurden mit einem Standard-TEE-System verglichen. Alle Patienten wurden von unabhängigen Untersuchern randomisiert mit beiden Systemen untersucht; dabei wurde einem festgelegten Untersuchungsgang gefolgt. Die Bildqualität der zweidimensionalen Darstellung der kardialen Standardschnittebenen und der Spektraldoppleruntersuchungen wurden auf einer visuellen Analogskala bewertet. Es erfolgte eine Dokumentation der Untersuchungszeiten. Ergebnisse: In der zweidimensionalen Darstellung der Standardschnittebenen konnten keine Unterschiede zwischen den zwei Systemen detektiert werden. Bei einigen Spektraldopplerdarstellungen war das Standardsystem dem miniaturisierten System überlegen. Schlussfolgerung: Die bettseitige Akutdiagnostik eines hämodynamisch instabilen Intensivpatienten ist mit einem miniaturisierten TEE-System hinreichend aussagekräftig.

Purpose: We examined the feasibility of a newly developed handheld ultrasound device capable of transesophageal echocardiography (TEE). Materials and Methods: Prospective case series in a non-cardiac surgical intensive care unit including 18 deeply sedated and endotracheally intubated critically ill non-cardiac surgical patients. The imaging quality and findings of a newly developed handheld device were compared to those of a cart-based standard TEE system. All patients were examined with both systems in a randomized order by independent examiners performing a structured and complete TEE examination. The imaging quality of the standard cardiac cross sections and spectral Doppler studies of the cardiac valves was assessed on an analog scale from 1 (excellent) to 5 (insufficient). The time requirements for each study were documented. Results: We did not detect significant differences in two-dimensional imaging. Continuous-wave Doppler imaging of the left ventricular outflow tract and pulsed-wave Doppler imaging of the transmitral flow were significantly better (p < 0.001) with the standard system. Conclusion: Handheld TEE is a goal-oriented diagnostic tool, which may sufficiently replace a standard cart-based TEE system in unstable critically ill patients when an acute gross diagnosis is required.

Key words

heart - echocardiography - anesthesia

References

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