Cardiothoracic & vascular anesthesia
Derivation of a pragmatic three-view protocol for point-of-care transesophageal echocardiography in the cardiovascular ICU: a real-world cohort study
Authors' conclusion
POCUS-TEE frequently drives urgent interventions in postoperative hemodynamic instability. Although the sequence of diagnostic capture is operator-dependent, a simple three-view protocol provides > 90% diagnostic coverage.
Study context
- Population
- Consecutive adult cardiovascular ICU admissions over five years undergoing POCUS-TEE
- Participants
- 6,898 participants · 353 POCUS-TEE examinations
- Outcome
- Diagnostic coverage of a derived minimal TEE view set (first informative view) in hemodynamically unstable examinations
Methodological detailssingle-center, consecutive admissions, derivation
- Single-center
- Consecutive admissions
- Derivation
Main finding
As reported in the abstract
Diagnostic coverage of three-view set
92.4%
Observational data: associations, not effects.
Further findings
POCUS-TEE use among admissions
- Examinations performed (353)
- 5.1%
- Predominantly in patients with higher severity scores vs those without TEE
Altered planned surgery, preoperative stable patients (subgroup, n = 37)
- Altered planned surgery in 6 patients
- 16.2%
Management changes, postoperative stable patients (subgroup, n = 101)
- Included optimization of mechanical support and anticoagulation
Procedural interventions, postoperative-unstable examinations (subgroup, n = 238)
- Prompted procedural interventions
- 79.4%
Inter-rater reproducibility
- First diagnostic view agreement (κ)
- 0.06-0.11
- Core three-view set, Jaccard similarity coefficient
- 0.60
- Agreement on management decisions moderate
Safety
Procedure-related complications during bedside POCUS-TEE
- Procedure-related complications
- 0
Original publication
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