TY  - CHAP
M1  - Book, Section
TI  - TRANSESOPHAGEAL ECHOCARDIOGRAPHY: IMAGE ACQUISITION AND TRANSDUCER MANIPULATION
A1  - Lakticova, Viera
A1  - Mayo, Paul H.
A2  - Levitov, Alexander B.
A2  - Mayo, Paul H.
A2  - Slonim, Anthony D.
PY  - 2015
T2  - Critical Care Ultrasonography, 2e
AB  - The  value  of  performing  transesophageal  echocardiography  (TEE)  in  the  intensive  care  unit  (ICU)  is  well  established.  Although  transthoracic  echocardiography  (TTE)  is  a  useful  diagnostic  tool  in  the  ICU,  TEE  has  superior  diagnostic  accuracy  and  therapeutic  impact  in  several  clinical  situations,  particularly  for  patients  in  shock  states.1–3  Several  authors  have  demonstrated  that  TEE  findings  lead  to  major  therapeutic  decisions  between  43%  and  68%  of  the  time.1,4–6  TEE  produces  good  image  quality  due  to  the  position  of  the  probe  proximate  to  the  heart,  allowing  for  the  use  of  higher  frequency  ultrasound  with  superior  resolution  of  cardiac  structures  than  with  TTE.  Although  improvements  in  imaging,  software,  and  portable  systems  have  reduced  the  rates  of  inadequate  image  quality  seen  with  TTE,  there  remain  a  significant  percentage  of  patients  in  the  ICU  whose  image  quality  with  TTE  is  inadequate.  Many  factors  account  for  this  including  inadequate  patient  positioning,  lung  hyperinflation,  obesity,  edema,  and  the  presence  of  chest  devices,  wounds,  and  dressings.  TTE  results  in  adequate  image  quality  in  approximately  55%  of  mechanically  ventilated  ICU  patients,  with  the  remaining  23%  and  22%  of  studies  being  of  suboptimal  and  poor  quality,  respectively.3  In  addition  to  overcoming  poor  image  quality  of  TTE,  TEE  is  often  necessary  for  the  evaluation  of  specific  diagnoses  in  the  ICU  such  as  endocarditis,  identifying  an  embolic  source,  intracardiac  shunt,  aortic  dissection,  and  loculated  pericardial  effusion.  For  hemodynamic  assessment,  TEE  is  the  only  method  to  assess  superior  vena  cava  (SVC)  variation,  a  predictor  of  volume  responsiveness.7  When  compared  with  helical  computed  tomography  (CT),  TEE  has  good  sensitivity  and  specificity  for  central  pulmonary  embolism  (PE)  associated  with  right  ventricular  dilatation.8,9  
SN  - 
PB  - McGraw-Hill Education
CY  - New York, NY
Y2  - 2024/04/18
UR  - accessanesthesiology.mhmedical.com/content.aspx?aid=1106128859
ER  -