The influence of transoesophageal echocardiography on intra-operative decision making. A European multicentre study. European Perioperative TOE Research Group.
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.
Kolev
N
N
Ludwig Boltzmann Institut für Klinische Anaesthesiologie und Intensivmedizin, Allgemeines Krankenhaus, Wien, Austria.
Brase
R
R
Swanevelder
J
J
Oppizzi
M
M
Riesgo
M J
MJ
van der Maaten
J M
JM
Abiad
M G
MG
Guarracino
F
F
Zimpfer
M
M
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