title: Surgeon-Performed Hemodynamic Transesophageal Echocardiography in the Burn Intensive Care Unit.
abstract: The use of transesophageal echocardiography (TEE) for resuscitation after burn injury has been reported in small case studies. Conventional TEE is invasive and often requires a subspecialist with a high level of training. The authors report a series of surgeon-performed hemodynamic TEE with an indwelling, less bulky, user-friendly probe. Records of patients treated in a regional burn center who underwent hemodynamic TEE between October 1, 2012 and May 30, 2014 were reviewed. The clinical course of each patient was recorded. All bedside interpretations were retrospectively reviewed for accuracy by a cardiac anesthesiologist. Eleven patients were included in the study. Median age was 68.5 years (interquartile range, 49.5-79.5). Median burn size was 37% TBSA (interquartile range: 16.3-53%). Seven patients were male, and four suffered inhalation injury. The operator's interpretation matched that of the echocardiography technician and cardiac anesthesiologist in all instances. No complications occurred from probe placement. Four patients underwent hemodynamic TEE to determine volume status during resuscitation. Changes in volume status on echocardiography preceded the eventual changes in urine output and vital signs for one patient. Hemodynamic TEE diagnosed cardiogenic shock and was used to titrate inotropes and vasopressors in seven elderly patients. Hemodynamic TEE is a useful adjunct to manage the burn patient who deviates off the expected course, especially if there is a question of cardiac function or volume status. It is less invasive and can be accurately performed by surgical intensivists when transthoracic echo windows are limited. The role of echocardiography in optimizing routine burn resuscitations needs to be further studied.
authors.affiliation: From the *Department of Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee; †Department of Anesthesiology, ‡Division of Trauma and Surgical Critical Care, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Jenny M
authors.initials: JM
authors.lastname: Held
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Litt
authors.forename: Jason D
authors.initials: JD
authors.lastname: Kennedy
authors.forename: Stuart
authors.initials: S
authors.lastname: McGrane
authors.forename: Oliver L
authors.initials: OL
authors.lastname: Gunter
authors.forename: Lisa
authors.initials: L
authors.lastname: Rae
authors.forename: Steven A
authors.initials: SA
authors.lastname: Kahn
mesh_terms: D000368:Aged; D002056:Burns / Q000000981:diagnostic imaging* / Q000503:physiopathology; D002983:Clinical Competence; D017548:Echocardiography, Transesophageal; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D019095:Point-of-Care Systems; D015203:Reproducibility of Results; D012189:Retrospective Studies