title: Feasibility and influence of hTEE monitoring on postoperative management in cardiac surgery patients.
abstract: Monoplane hemodynamic TEE (hTEE) monitoring (ImaCor(®) ClariTEE(®)) might be a useful alternative to continuously evaluate cardiovascular function and we aimed to investigate the feasibility and influence of hTEE monitoring on postoperative management in cardiac surgery patients. After IRB approval we reviewed the electronic data of cardiac surgery patients admitted to our intensive care between 01/01/2012 and 30/06/2013 in a case-controlled matched-pairs design. Patients were eligible for the study when they presented a sustained hemodynamic instability postoperatively with the clinical need of an extended hemodynamic monitoring: (a) hTEE (hTEE group, n = 18), or (b) transpulmonary thermodilution (control group, n = 18). hTEE was performed by ICU residents after receiving an approximately 6-h hTEE training session. For hTEE guided hemodynamic optimization an institutional algorithm was used. The hTEE probe was blindly inserted at the first attempt in all patients and image quality was at least judged to be adequate. The frequency of hemodynamic examinations was higher (ten complete hTEE examinations every 2.6 h) in contrast to the control group (one examination every 8 h). hTEE findings, including five unexpected right heart failure and one pericardial tamponade, led to a change of current therapy in 89% of patients. The cumulative dose of epinephrine was significantly reduced (p = 0.034) and levosimendan administration was significantly increased (p = 0.047) in the hTEE group. hTEE was non-inferior to the control group in guiding norepinephrine treatment (p = 0.038). hTEE monitoring performed by ICU residents was feasible and beneficially influenced the postoperative management of cardiac surgery patients.
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany. sascha.treskatsch@charite.de.
authors.forename: S
authors.initials: S
authors.lastname: Treskatsch
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
authors.forename: F
authors.initials: F
authors.lastname: Balzer
authors.affiliation: Department of Cardiology, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: F
authors.initials: F
authors.lastname: Knebel
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Habicher
authors.affiliation: Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Klinikum Hildesheim GmbH, Hildesheim, Germany.
authors.forename: J P
authors.initials: JP
authors.lastname: Braun
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Kastrup
authors.affiliation: Department of Cardiovascular Surgery, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Grubitzsch
authors.affiliation: SOSTANA GmbH, Berlin, Germany.
authors.forename: K-D
authors.initials: KD
authors.lastname: Wernecke
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Spies
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Sander
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D002305:Cardiac Tamponade / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D002317:Cardiovascular Agents / Q000008:administration & dosage; D018618:Echocardiography, Doppler, Color / Q000295:instrumentation / Q000379:methods*; D017548:Echocardiography, Transesophageal / Q000295:instrumentation / Q000379:methods*; D004503:Education, Medical, Graduate; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D005858:Germany; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D006439:Hemodynamics; D006801:Humans; D007362:Intensive Care Units; D007396:Internship and Residency; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000295:instrumentation / Q000379:methods*; D011182:Postoperative Care / Q000193:education / Q000295:instrumentation / Q000379:methods*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D013997:Time Factors; D014159:Transducers; D016896:Treatment Outcome
chemical_list: D002317:Cardiovascular Agents
keywords: Cardiac surgery; Echocardiography; Goal directed therapy; Monoplane probe; Postoperative management; hTEE