title: The influence of transoesophageal echocardiography on intra-operative decision making. A European multicentre study. European Perioperative TOE Research Group.
abstract: The role of transoesophageal echocardiography (TOE) in anaesthesia remains controversial because it is a rapidly evolving technique with few proven benefits and considerable cost. Recently, the Society of Cardiovascular Anaesthesiologists has published practice guidelines for the use of peri-operative TOE. To determine the current role of transoesophageal echocardiography and the relative impact of category-based transoesophageal echocardiographic indications the present study investigated its use in seven Western European countries. The study sample was taken from a prospective cohort of 224 patients with acute or chronic haemodynamic disturbances or at risk of myocardial ischaemia. All patients were monitored with two-lead electrocardiography and radial and pulmonary artery catheters, as well as biplane or multiplane transoesophageal echocardiography. A total of 2232 clinical interventions were made in these patients. The most frequently observed intervention was the administration of a fluid bolus (45% of all interventions). Overall, transoesophageal echocardiography was the most important guiding factor in 560 (25%) interventions. It was the most important monitor in guiding the following therapeutic interventions: anti-ischaemic therapy--207 of 372 interventions (56%); fluid administration--275 of 996 (28%) interventions; vasopressor or inotrope administration--56 of 316 (16%) interventions; vasodilator therapy--six of 142 (4%) interventions and depth of anaesthesia--four of 211 (2%) interventions. We found that transoesophageal echocardiography is frequently influential in guiding clinical decision making and is used most frequently for category II indications but category I indications were associated with more frequent change in management.
authors.affiliation: Ludwig Boltzmann Institut für Klinische Anaesthesiologie und Intensivmedizin, Allgemeines Krankenhaus, Wien, Austria.
authors.forename: N
authors.initials: N
authors.lastname: Kolev
authors.forename: R
authors.initials: R
authors.lastname: Brase
authors.forename: J
authors.initials: J
authors.lastname: Swanevelder
authors.forename: M
authors.initials: M
authors.lastname: Oppizzi
authors.forename: M J
authors.initials: MJ
authors.lastname: Riesgo
authors.forename: J M
authors.initials: JM
authors.lastname: van der Maaten
authors.forename: M G
authors.initials: MG
authors.lastname: Abiad
authors.forename: F
authors.initials: F
authors.lastname: Guarracino
authors.forename: M
authors.initials: M
authors.lastname: Zimpfer
mesh_terms: D000328:Adult; D000368:Aged; D000768:Anesthesia, General; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging*; D013504:Cardiovascular Surgical Procedures; D003657:Decision Making; D017548:Echocardiography, Transesophageal; D004562:Electrocardiography; D005260:Female; D005440:Fluid Therapy; D006801:Humans; D007430:Intraoperative Care; D007431:Intraoperative Complications / Q000628:therapy; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D017202:Myocardial Ischemia / Q000628:therapy; D011446:Prospective Studies; D012307:Risk Factors