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首页> 外文期刊>The Internet Journal of Emergency and Intensive Care Medicine >Initial Experience with a Disposable Transesophageal Echocardiography Monitoring System during Therapeutic Hypothermia following out of Hospital Cardiac Arrest
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Initial Experience with a Disposable Transesophageal Echocardiography Monitoring System during Therapeutic Hypothermia following out of Hospital Cardiac Arrest

机译：医院心脏骤停后治疗性体温过低的一次性经食道超声心动图监测系统的初步经验

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Objective: This investigation summarizes the initial clinical experience of trained echocardiographers who utilized a miniaturized disposable monoplane transesophageal echocardiography (TEE) system in patients undergoing therapeutic hypothermia following out of hospital cardiac arrest.Design: A retrospective, single-center, observational study. Setting: A tertiary care university hospital.Patients: We retrospectively reviewed the medical records of 13 consecutive patients undergoing therapeutic hypothermia following out of hospital cardiac arrest in which a disposable monoplane TEE probe was placed to observe myocardial recovery and potentially guide hemodynamic optimization. Measurements and Main Results: A total of 40 imaging sessions were performed. The success rate for obtaining the mid-esophageal four chamber and the transgastric mid-papillary short axis views were 92.5% and 100% respectively. Endocardial border definition was adequate in 90% of imaging sessions to measure left ventricular end diastolic and systolic areas enabling calculation of fractional area of change. Assessment of right ventricular function was possible in 92.5% of imaging sessions.A significant number of imaging sessions (12/40, 30%) provided information that clarified the patient’s biventricular function in the setting of ambiguous invasive pressure monitoring measurements.Conclusions: Acquisition of a mid esophageal four chamber and transgastric mid papillary view was possible with the miniaturized disposable TEE probe in the vast majority of imaging sessions. This information enabled the qualitative assessment of right ventricular function, measurement of left ventricular end systolic, and diastolic area with a high degree of success in patients during therapeutic hypothermia following cardiac arrest. The authors postulate that serial assessment of biventricular function and filling with serial TEE imaging provides information that cannot be reliably inferred from other advanced hemodynamic monitoring devices in routine clinical practice. This work was funded by the Department of Anesthesiology at Vanderbilt University Medical Center. Introduction Therapeutic hypothermia is an important evidence-based and cost effective therapy following resuscitation from out-of-hospital non-traumatic cardiac arrest [1]. Following resuscitation, practice guidelines recommend early hemodynamic optimization, however specific goals of resuscitation including central venous pressure, mean arterial pressure, mixed venous oxygen saturation, hematocrit, lactate, urine output, and oxygen delivery index are not supported by prospective evaluation [2]. Echocardiography and cardiac output monitoring are recognized advanced monitoring tools to guide hemodynamic optimization in this patient population [2,3]. Recent literature has called into question the accuracy of cardiac output monitoring techniques during hemodynamic instability [4-6]. Practice guidelines generally favor TEE rather than transthoracic echocardiography in mechanically ventilated patients [7]. The challenges of using conventional TEE systems to monitor cardiac function and filling in the ICU setting have been previously described [8]. The ClariTEE? (Imacor, Uniondale, NY), a miniaturized disposable monoplane TEE probe is approved by the United States Food and Drug Administration to monitor cardiac function and filling for up to 72 hours in mechanically ventilated patients. The initial clinical experience of trained echocardiogpher’s who utilized this disposable TEE system in 13 patients undergoing therapeutic hypothermia following out-of-hospital cardiac arrest is described. Materials and Methods This retrospective review was performed after the creation of an Institutional Review Board approved registry of patients undergoing therapeutic hypothermia following out-of-hospital cardiac arrest. Inclusion criteria for the hypothermia protocol included patients over the age of 18 years, estimated time from cardi
机译：目的：本研究总结了受过训练的超声心动图医师的初步临床经验，他们使用微型一次性单平面经食道超声心动图（TEE）系统对因院外心脏骤停而接受治疗性低温的患者进行了设计：一项回顾性，单中心，观察性研究。地点：一所三级大学医院。患者：我们回顾性分析了13例连续性患者在离开医院心脏骤停后接受治疗性低温治疗的病历，其中放置了一次性单翼TEE探针以观察心肌恢复并可能指导血液动力学优化。测量和主要结果：总共进行了40次成像会议。食管中段四腔和经胃中乳头短轴视图的成功率分别为92.5％和100％。在90％的影像学检查中，心内膜边界定义足以测量左心室舒张末期和收缩期的面积，从而计算出变化的分数面积。在92.5％的影像学会议中可以评估右心室功能。大量影像学会议（12/40，30％）提供的信息可以澄清患者在有创侵入性压力监测测量中的双室功能。在绝大多数成像过程中，使用微型一次性TEE探头可以实现食管中段四腔和胃中部乳头状视图。该信息可以对心脏骤停后的治疗性低温患者的右心室功能，左心室收缩末期和舒张面积进行定性评估，并获得很高的成功率。作者推测，双室功能的连续评估和连续TEE成像的填充提供了常规临床实践中无法从其他先进的血液动力学监测设备可靠地推断出的信息。这项工作由范德比尔特大学医学中心麻醉学系资助。引言低温治疗是院外非创伤性心脏骤停复苏后的一种重要的循证且经济有效的治疗方法[1]。复苏后，实践指南建议尽早优化血流动力学，但是前瞻性评估不支持复苏的具体目标，包括中心静脉压，平均动脉压，混合静脉血氧饱和度，血细胞比容，乳酸，尿量和氧气输送指数[2]。超声心动图和心输出量监测是公认的先进监测工具，可指导该患者群体的血流动力学优化[2,3]。最近的文献对血流动力学不稳定期间心输出量监测技术的准确性提出了质疑[4-6]。对于机械通气患者，实践指南通常倾向于TEE而非经胸超声心动图检查[7]。先前已经描述了使用常规TEE系统监测心脏功能和ICU设置的挑战[8]。 ClariTEE？ （Imacor，Uniondale，NY）是一种小型的一次性单翼TEE探针，已获得美国食品和药物管理局的批准，可监测机械通气患者的心脏功能和充盈长达72小时。描述了受过训练的超声心动图专家的初步临床经验，他们在13例院外心脏骤停后接受治疗性体温过低的患者中使用了这种一次性TEE系统。材料和方法这项回顾性研究是在医院院外心脏骤停后，经过机构审查委员会批准的对治疗性体温过低的患者进行登记后进行的。体温过低方案的纳入标准包括18岁以上的患者（估计得自心脏的时间）

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