title: Hemodynamic assessment of ventilated ICU patients with cardiorespiratory failure using a miniaturized multiplane transesophageal echocardiography probe.
abstract: OBJECTIVE
  To assess the feasibility, image quality, diagnostic accuracy, therapeutic impact and tolerance of diagnostic and hemodynamic assessment using a novel miniaturized multiplane transesophageal echocardiography (TEE) probe in ventilated ICU patients with cardiopulmonary compromise.
  
  
  METHODS
  Prospective, descriptive, single-center study.
  
  
  METHODS
  Fifty-seven ventilated patients with acute circulatory or respiratory failure were assessed, using a miniaturized multiplane TEE probe and a standard TEE probe used as reference, randomly by two independent experienced operators. Measurements of hemodynamic parameters were independently performed off-line by a third expert. Diagnostic groups of acute circulatory failure (n = 5) and of acute respiratory failure (n = 3) were distinguished. Hemodynamic monitoring was performed in 9 patients using the miniaturized TEE probe. TEE tolerance and therapeutic impact were reported.
  
  
  RESULTS
  The miniaturized TEE probe was easier to insert than the standard TEE probe. Despite lower imaging quality of the miniaturized TEE probe, the two probes had excellent diagnostic agreement in patients with acute circulatory failure (Kappa: 0.95; 95% CI: 0.85-1) and with acute respiratory failure (Kappa: 1; 95% CI: 1.0-1.0). Accordingly, therapeutic strategies derived from both TEE examinations were concordant (Kappa: 0.82; 95% CI: 0.66-0.97). The concordance between quantitative hemodynamic parameters obtained with both TEE probes was also excellent. No relevant complication secondary to TEE probes insertion occurred.
  
  
  CONCLUSIONS
  Hemodynamic assessment of ventilated ICU patients with cardiopulmonary compromise using a miniaturized multiplane TEE probe appears feasible, well-tolerated, and relevant in terms of diagnostic information and potential therapeutic impact. Further larger-scale studies are needed to confirm these preliminary results.
authors.affiliation: Medical-Surgical ICU, Réanimation Polyvalente, CHU Dupuytren, Dupuytren University Hospital, 2 avenue Martin Luther King, 87042, Limoges, France.|Faculty of Medicine, University of Limoges, Limoges, France.|Inserm CIC1435, Limoges, France.
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Begot
authors.affiliation: Department of Biostatistics, INSERM UMR1094, Limoges, France.
authors.forename: François
authors.initials: F
authors.lastname: Dalmay
authors.affiliation: Inserm CIC1435, Limoges, France.
authors.forename: Caroline
authors.initials: C
authors.lastname: Etchecopar
authors.affiliation: Medical-Surgical ICU, Réanimation Polyvalente, CHU Dupuytren, Dupuytren University Hospital, 2 avenue Martin Luther King, 87042, Limoges, France.|Inserm CIC1435, Limoges, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Clavel
authors.affiliation: Medical-Surgical ICU, Réanimation Polyvalente, CHU Dupuytren, Dupuytren University Hospital, 2 avenue Martin Luther King, 87042, Limoges, France.|Inserm CIC1435, Limoges, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Pichon
authors.affiliation: Medical-Surgical ICU, Réanimation Polyvalente, CHU Dupuytren, Dupuytren University Hospital, 2 avenue Martin Luther King, 87042, Limoges, France.|Inserm CIC1435, Limoges, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Francois
authors.affiliation: Department of Medicine, Section of Cardiology, University of Chicago, Chicago, IL, USA.
authors.forename: Roberto
authors.initials: R
authors.lastname: Lang
authors.affiliation: Medical-Surgical ICU, Réanimation Polyvalente, CHU Dupuytren, Dupuytren University Hospital, 2 avenue Martin Luther King, 87042, Limoges, France. philippe.vignon@unilim.fr.|Faculty of Medicine, University of Limoges, Limoges, France. philippe.vignon@unilim.fr.|Inserm CIC1435, Limoges, France. philippe.vignon@unilim.fr.
authors.forename: Philippe
authors.initials: P
authors.lastname: Vignon
mesh_terms: D000368:Aged; D017548:Echocardiography, Transesophageal / Q000295:instrumentation* / Q000379:methods; D005260:Female; D006333:Heart Failure / Q000175:diagnosis*; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008904:Miniaturization / Q000295:instrumentation / Q000379:methods; D008991:Monitoring, Physiologic / Q000295:instrumentation / Q000379:methods; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000175:diagnosis*; D012769:Shock / Q000175:diagnosis*
keywords: Critical care echocardiography; Echocardiography; Hemodynamic monitoring; Transesophageal echocardiography