Hemodynamic monitoring using a single-use indwelling transesophageal echocardiography probe in an unstable patient after open-heart surgery.
BACKGROUND
Hemodynamic monitoring is frequently needed in ventilated patients with unstable hemodynamics after open-heart surgery. Novel miniaturized single-use transesophageal echocardiographic probe has been scarcely used in this clinical setting.


METHODS
A patient who underwent a scheduled open-heart surgery developed a ventilator-associated pneumonia and was referred to the intensive care unit for post-operative acute respiratory distress syndrome. Hemodynamic monitoring was performed with a single-use indwelling transesophageal echocardiography probe during 50 h. Initially, a contrast study depicted a patent foramen ovale with a right-to-left shunt. Nitric oxide was administered and positive end-expiration pressure was reduced. Subsequently, the patient became hemodynamically unstable and the identification of a localized tamponade due to compressive left atrial hematoma prompted reoperation.


CONCLUSIONS
The novel hemodynamic monitoring device described here appears valuable to help identifying severe post-operative complications and guide acute care.
Medical-surgical intensive care unit, Dupuytren University Hospital, 2 Ave. Martin Luther King, 87042, Limoges, France. emmanuellebegot@yahoo.fr.
Emmanuelle
E
Begot
Medical-surgical intensive care unit, Dupuytren University Hospital, 2 Ave. Martin Luther King, 87042, Limoges, France. marc.clavel@chu-limoges.fr.|Inserm, CIC-1435, F-87000, Limoges, France. marc.clavel@chu-limoges.fr.
Marc
M
Clavel
Department of Thoracic and Cardiovascular Surgery, Dupuytren University Hospital, Limoges, France. alessandro.piccardo@chu-limoges.fr.
Alessandro
A
Piccardo
Medical-surgical intensive care unit, Dupuytren University Hospital, 2 Ave. Martin Luther King, 87042, Limoges, France. remybellier@yahoo.fr.
Rémi
R
Bellier
Medical-surgical intensive care unit, Dupuytren University Hospital, 2 Ave. Martin Luther King, 87042, Limoges, France. b.francois@unilim.fr.|Inserm, CIC-1435, F-87000, Limoges, France. b.francois@unilim.fr.
Bruno
B
François
Medical-surgical intensive care unit, Dupuytren University Hospital, 2 Ave. Martin Luther King, 87042, Limoges, France. nicolas.pichon@chu-limoges.fr.|Inserm, CIC-1435, F-87000, Limoges, France. nicolas.pichon@chu-limoges.fr.
Nicolas
N
Pichon
Medical-surgical intensive care unit, Dupuytren University Hospital, 2 Ave. Martin Luther King, 87042, Limoges, France. philippe.vignon@unilim.fr.|Inserm, CIC-1435, F-87000, Limoges, France. philippe.vignon@unilim.fr.|Université de Limoges, F-87000, Limoges, France. philippe.vignon@unilim.fr.
Philippe
P
Vignon
D002305:Cardiac Tamponade / Q000209:etiology / Q000601:surgery; D017548:Echocardiography, Transesophageal / Q000295:instrumentation* / Q000379:methods; D006331:Heart Diseases / Q000601:surgery*; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D009569:Nitric Oxide / Q000008:administration & dosage*; D011182:Postoperative Care; D011183:Postoperative Complications / Q000628:therapy*; D012128:Respiratory Distress Syndrome / Q000209:etiology* / Q000628:therapy
D009569:Nitric Oxide