Handheld vs. conventional transesophageal echocardiography in non-cardiac surgical intensive care unit patients

We examined the feasibility of a newly developed handheld ultrasound device capable of transesophageal echocardiography (TEE).

Prospective case series in a non-cardiac surgical intensive care unit including 18 deeply sedated and endotracheally intubated critically ill non-cardiac surgical patients. The imaging quality and findings of a newly developed handheld device were compared to those of a cart-based standard TEE system. All patients were examined with both systems in a randomized order by independent examiners performing a structured and complete TEE examination. The imaging quality of the standard cardiac cross sections and spectral Doppler studies of the cardiac valves was assessed on an analog scale from 1 (excellent) to 5 (insufficient). The time requirements for each study were documented.

We did not detect significant differences in two-dimensional imaging. Continuous-wave Doppler imaging of the left ventricular outflow tract and pulsed-wave Doppler imaging of the transmitral flow were significantly better (p <0.001) with the standard system.

Handheld TEE is a goal-oriented diagnostic tool, which may sufficiently replace a standard cart-based TEE system in unstable critically ill patients when an acute gross diagnosis is required.