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Category Archives: Critically III Patients

Usefulness of Transesophageal Echocardiography in the Treatment of Critically III Patients: Conclusion

Usefulness of Transesophageal Echocardiography in the Treatment of Critically III Patients: ConclusionTransthoracic echocardiography is particularly limited in the assessment of mechanical valve dysfunction because of acoustic shadow interference reflected by the mechanical prosthesis. Transesophageal echocardiography should be used in the assessment of suspected prosthetic valve dysfunction in the critically ill patients to identify the cause and allow possible intervention directed toward the prevention of additional sequelae. In cases of sudden and unexplained hemodynamic deterioration in patients with critical illness, TEE is useful for searching the underlying causes if TTE gave unsatisfactory results.
Recent reports have documented the greater accuracy of TEE for detecting left atrial appendage thrombus or spontaneous echo contrast that was the indicator of a higher risk for systemic embolization. Our experience in 11 patients revealed the potential cardiac source of embolism in nine patients by TEE, but in none of them by TTE. Although confirmatory tests were not performed in this group, the diagnostic yield of TEE in the detection of left atrial thrombi is high in our recent study, using surgicopathologic findings as the gold standard.
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Usefulness of Transesophageal Echocardiography in the Treatment of Critically III Patients: Discussion

In this study, TEE provided critical information that was not obtained by TTE in 39 of 78 studies (50 percent). There were two failed TEE attempts. Cardiac surgery was prompted by TEE findings in 14 patients (18 percent) and these findings were all confirmed at operation. There were no major compliDue to the proximity of the heart and esophagus, TEE has proved to be very useful in the diagnosis of various cardiac diseases. The safety has also been documented. However, it was rarely evaluated in the treatment of critically ill patients for whom prompt and accurate diagnoses were important. The most common indication for TEE in our study was the evaluation of aortic dissection. We proved TEE to have greater sensitivity in the diagnosis of aortic dissection than that of TTE, consistent with recent reports. Cardiac surgery was performed in five patients with aortic dissection and hypotension after the TEE study without other examinations. Accurate and rapid diagnoses are critical to these patients when hemodynam-ically unstable. They were too critically ill to be removed from the ICU. In this regard, TEE was superior to other examinations such as computed tomography, magnetic resonance imaging, and aortography, because not only could TEE be performed quickly and safely at bedside without moving the patient or injecting contrast media, but TEE also could provide accurate information about the site and number of intimal tears and branch involvement of dissection important in surgical planning.
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Usefulness of Transesophageal Echocardiography in the Treatment of Critically III Patients: Complications

Usefulness of Transesophageal Echocardiography in the Treatment of Critically III Patients: ComplicationsTransesophageal echocardiography demonstrated hyperdynamic small left ventricular cavity that was consistent with significant intravascular volume depletion (n = 3), severe left ventricular dysfunction (n – 3), right ventricular infarction (n = 2), ventricular septal rupture following myocardial infarction (n = 1), traumatic ventricular septal defect falling from height (n = 1), dehisced poly-tetrafluorethylene (Gore-Tex) graft after total cavopulmonary connection of complex congenital heart disease (n – 1), and patent ductus arteriosus (n = 1) in the remaining patients. In the patient with patent ductus arteriosus, the size of the duct was large (2 cm in diameter) resulting in high cardiac output heart failure that subsided after ligation of the patent ductus. Transesophageal echocardiography detected an atrial septal aneurysm bulging toward the left atrium and right to-left shunt through a patent foramen ovale in one patient with right ventricular infarction and persistent hypoxemia despite 100 percent oxygen therapy. Transthoracic echocardiography was unable to detect the mechanical valve thrombus in three patients, dehisced Gore-Tex graft, patent ductus arteriosus, postinfarction ventricular septal rupture, and atrial septal aneurysm with patent foramen ovale each in a single patient, and ruptured chordae tendineae in two patients (Table 2). In the group with hemodynamic instability, nine patients underwent cardiac surgery that confirmed the TEE findings in all. Of these, three patients with mechanical valve thrombus, two with acute mitral regurgitation due to ruptured chordae tendineae, one with dehisced Gore-Tex graft, and one with postinfarction ventricular septal rupture directly underwent surgery after the TEE diagnosis. canadian pharmacy

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Usefulness of Transesophageal Echocardiography in the Treatment of Critically III Patients: Results

A total of 80 TEE studies were attempted in 80 patients. Transesophageal probe was passed successfully in 78 of 80 attempts (98 percent). The causes of failure to pass the probe into the esophagus include poor cooperation in one awake patient and esophageal narrowing in one ventilated patient.
Indications
The indications for TEE imaging included suspected aortic dissection in 34 patients, hemodynamic instability in 22, suspected cardiac source of embolism in 11, evaluation of mitral regurgitation severity in 7, and suspected infective endocarditis in 6. The indications for TEE study in 48 ICU patients and in 32 emergency department patients are listed in Table 1. Systolic blood pressure <90 mm Hg and heart rate >100 beats per minute occurred in 20 patients (25 percent). These included aortic wall rupture in two, aortic dissection in five, hypovolemic shock in three, cardiogenic shock in six, major stroke in two, and infective endocarditis in two. Ten of the 17 patients who were mechanically ventilated were in the shock state. canadianneighborpharmacy.com

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Usefulness of Transesophageal Echocardiography in the Treatment of Critically III Patients: Methods

Usefulness of Transesophageal Echocardiography in the Treatment of Critically III Patients: MethodsAccurate and prompt diagnoses are crucial to critically ill patients. Transthoracic echocardiography (TTE) has proved to be of great value in the critical care setting because of its portability, widespread availability, and instantaneous diagnostic capability. However, TTE is frequently unsatisfactory in the critical care setting due to the high percentage of technically inadequate studies in the critically ill patients, especially when the patient has chest wall interference or is mechanically ventilated. Transesophageal echocardiography (TEE), a new window to the heart, can overcome the constraints and provide more information about the cardiac abnormalities than TTE. Therefore, TEE is a useful adjuvant in the treatment of critically ill patients. However, only a few reports have described this important application of TEE in critically ill patients and to our knowledge, there have been no reports concerning the use of TEE in critically ill patients in the emergency department. In this study, we compared the usefulness of TTE and TEE in the treatment of critically ill patients in the ICU and in the emergency department in a 2-year period. canadian pharmacy mall

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