title: Non-invasive ventilation-aided transoesophageal echocardiography in high-risk patients: a pilot study.
abstract: OBJECTIVE
  Transoesophageal echocardiography (TEE) may require patient sedation, eventually leading to respiratory depression, a risky condition in severe cardiac disease. Non-invasive ventilation (NIV) has been applied during diagnostic manoeuvres, but its use during TEE has not been reported. We describe NIV-aided continuous TEE monitoring under sedation in the supine position in three consecutive orthopnoeic patients with severe aortic valve stenosis: two of them underwent percutaneous aortic valve implantation, and one underwent aortic valvuloplasty.
  
  
  RESULTS
  The TEE probe was passed through a hole performed with a surgical cutter in an NIV face-mask. Pulsoximetry, heart rate, arterial blood pressure, respiratory rate, arterial blood gases, patients' comfort, and patient's sedation were monitored throughout the procedure. Percutaneous aortic valve implantation procedures lasted almost 2 h, while the valvuloplasty procedure lasted 70 min. Non-invasive ventilation and continuous TEE were performed throughout the procedures without technical problems or respiratory or haemodynamic complications, and all patients felt always comfortable.
  
  
  CONCLUSIONS
  Non-invasive ventilation through a modified face-mask allowed to perform continuous TEE examination and to avoid tracheal intubation and general anaesthesia in three high-risk patients undergoing beating heart treatment of aortic valve stenosis.
authors.affiliation: Cardiothoracic Anaesthesia and Intensive Care Medicine, Cardiothoracic Department, University Hospital of Pisa, Via Paradisa 2, Pisa, Italy. fabiodoc64@hotmail.com
authors.forename: Fabio
authors.initials: F
authors.lastname: Guarracino
authors.forename: Luca
authors.initials: L
authors.lastname: Cabrini
authors.forename: Rubia
authors.initials: R
authors.lastname: Baldassarri
authors.forename: Claudia
authors.initials: C
authors.lastname: Cariello
authors.forename: Remo Daniel
authors.initials: RD
authors.lastname: Covello
authors.forename: Giovanni
authors.initials: G
authors.lastname: Landoni
authors.forename: Sonia
authors.initials: S
authors.lastname: Petronio
authors.forename: Nicolino
authors.initials: N
authors.lastname: Ambrosino
mesh_terms: D000369:Aged, 80 and over; D000768:Anesthesia, General / Q000009:adverse effects*; D015906:Angioplasty, Balloon, Coronary; D001021:Aortic Valve; D002404:Catheterization / Q000295:instrumentation / Q000379:methods; D017548:Echocardiography, Transesophageal / Q000295:instrumentation* / Q000379:methods; D005260:Female; D006339:Heart Rate; D019918:Heart Valve Prosthesis Implantation / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D017214:Laryngeal Masks / Q000009:adverse effects; D008297:Male; D010092:Oximetry; D010865:Pilot Projects; D012121:Respiration, Artificial / Q000295:instrumentation / Q000379:methods*; D018570:Risk Assessment