views were recorded on the hard disk of the ul- trasound systems and ... hard drive. ..... of rapid ârescueâ perioperative echocardiography to improve outcomes ...
©
This document is protected by international copyright laws. No additional reproduction is authorized. It is permitted for personal use to download and save only one file and print only one copy of this Article. It is not permitted to make additional copies (either sporadically or systematically, either printed or electronic) of the Article for any purpose. It is not permitted to distribute the electronic copy of the article through online internet and/or intranet file sharing systems, electronic mailing or any other means which may allow access to the Article. The use of all or any part of the Article for any Commercial Use is not permitted. The creation of derivative works from the Article is not permitted. The production of reprints for personal or commercial use is not permitted. It is not permitted to remove, cover, overlay, obscure, block, or change any copyright notices or terms of use which the Publisher may post on the Article. It is not permitted to frame or use framing techniques to enclose any trademark, logo, or other proprietary information of the Publisher.
COPYRIGHT 2015 EDIZIONI MINERVA MEDICA
O R I G I N A L A RT I C L E
Focused intraoperative transthoracic echocardiography by anesthesiologists: a feasibility study T. KRATZ
1, 2 ,
M. CAMPO DELL’ORTO 3, M. EXNER 1, N. TIMMESFELD M. ZOREMBA 1, H. WULF 1, T. STEINFELDT 1
4
1Department
of Anaesthesia and Intensive Care Medicine, Philipps-University of Marburg, Marburg, Germany; of Anesthesia and Intensive Care Medicine, Clinique Bénigne Joly, Talant, France; 3Department of Cardiology, Kerckhoff Heart and Thorax Centre, Bad Nauheim, Germany; 4Institute of Medical Biometry and Epidemiology, Philipps-University of Marburg, Marburg, Germany 2Department
ABSTRACT Background. Focused transthoracic echocardiography (TTE) is frequently used perioperatively for hemodynamic monitoring and diagnosis of cardiovascular instability, but less commonly intraoperatively. Methods. To evaluate the feasibility of intraoperative TTE, we enrolled 222 anesthetised patients from August to November 2012 into a prospective observational study. 162 patients underwent TTE examination according to the Focused Assessed Transthoracic Echocardiography (FATE) protocol after positioning and draping for surgery. Sixty additional hemodynamically unstable subjects were examined during anesthesia and surgery. The imaging quality of four FATE views was rated on a scale from 1 (impossible) to 5 (perfect). TTE was assessed as applicable, if at least two of the four basic FATE views were graded 4 or 5, or three views were assessed as grade 3. Results. Imaging quality was unacceptable in 20 patients, resulting in a feasibility rate of 91% (97.5%-CI 0.86-1, P=0.01). TTE was feasible in hemodynamically unstable subjects (91.7%; 97.5%-CI 0.82-1.0), in orthopedic and trauma patients (>95% respectively, [97.5%-CI 0.83-1]) and in abdominal surgery (78%). Conclusion. TTE can be applied in the operating theatre during surgery, although its use during abdominal surgery is somewhat limited. (Minerva Anestesiol 2015;81:490-6) Key words: Echocardiography - Hemodynamics - Heart diseases.
P
erioperatively, non-invasive focused transthoracic echocardiography (TTE) examination is possible using portable ultrasound systems.1-5 It has been used for evaluation of critically ill patients, as it allows the rapid assessment of volume status and contractility of both ventricles. One transthoracic view is often considered sufficient for evaluation of cardiac function and volume load in unstable patients.5, 6 It is also a useful instrument for screening severe pathology.5, 6 Typical findings in unstable paComment in p. 469
490
tients are hypo- or hypervolemia, compromised left or right ventricular function, severe valvular pathology or left ventricular wall thickening.5 Though not allowing a comprehensive cardiac examination, this screening can have an immediate impact on patient management.5 However, intraoperative diagnostic TTE imaging quality is considered to be limited, due to e.g. mechanical ventilation, positioning and draping during surgery. The aim of the study was to assess its feasibility for various types of surgery in stable and unstable patients.
MINERVA ANESTESIOLOGICA
May 2015
©
This document is protected by international copyright laws. No additional reproduction is authorized. It is permitted for personal use to download and save only one file and print only one copy of this Article. It is not permitted to make additional copies (either sporadically or systematically, either printed or electronic) of the Article for any purpose. It is not permitted to distribute the electronic copy of the article through online internet and/or intranet file sharing systems, electronic mailing or any other means which may allow access to the Article. The use of all or any part of the Article for any Commercial Use is not permitted. The creation of derivative works from the Article is not permitted. The production of reprints for personal or commercial use is not permitted. It is not permitted to remove, cover, overlay, obscure, block, or change any copyright notices or terms of use which the Publisher may post on the Article. It is not permitted to frame or use framing techniques to enclose any trademark, logo, or other proprietary information of the Publisher.
COPYRIGHT 2015 EDIZIONI MINERVA MEDICA Feasibility of focused intraoperative TTE KRATZ
Materials and methods The study was approved by the Local Research Ethics Committee of the University Hospital of Marburg (AZ 82/12, 19 July 2012 and AZ 83/12, 12 October 2012) and written informed consent was obtained from all patients. Between August and November 2012 we included 222 consecutive patients in this single centre prospective observational study. Initially, 162 subjects were prospectively recruited at the premedication visit and divided into four groups representing different surgical fields: orthopedics and trauma, abdominal and vascular surgery, urology and gynecology, head or otonasorhinology. Exclusion criteria were cardiac surgery and age 120 beats per minute (bpm) or bradycardia
