Multiorgan Assessment with Transesophageal Ultrasound in Prone Ventilation Patients with Acute Respiratory Distress
Martín Isa1, Fernando A Sosa2, Lucía Bertorello-Andrade3
1Clínica Regional del Sud, Río Cuarto, Argentina.
Background And Aims:
In critically ill patients with acute respiratory distress syndrome (ARDS), especially during the COVID-19 pandemic, prolonged prone positioning complicated conventional monitoring. Transthoracic echocardiography (TTE) was often unfeasible, highlighting the need for alternative methods. Transesophageal ultrasound (TEUS) allows bedside, multiorgan assessment but has been underutilized in prone patients. To evaluate the feasibility and clinical utility of TEUS for multisystem monitoring in patients with moderate to severe ARDS in the prone position.
Patients And Methods:
This retrospective observational study was conducted in two ICUs in Argentina from October 2020 to October 2022. Adult patients with COVID-19-related ARDS who underwent TEUS while ventilated in the prone position were included. Certified intensivists performed standardized TEUS protocols to assess cardiac function, pulmonary status, and venous congestion using the venous excess ultrasound (VExUS) score.
Results:
Transesophageal ultrasound was performed in 109 patients. Assessment of left and right ventricular function, diastolic parameters, and lung patterns was feasible in nearly all cases. Right ventricular dysfunction was present in 36.7%, and VExUS-related congestion markers (portal pulsatility, hepatic/intrarenal vein changes) were frequent. Lung ultrasound via TEUS identified interstitial-alveolar patterns in 98.2%. Transesophageal ultrasound findings guided fluid and ventilatory management.
Conclusion:
Transesophageal ultrasound is a feasible, safe, and clinically valuable tool for comprehensive, real-time multisystem monitoring in prone, mechanically ventilated ARDS patients. It enables informed decision-making without patient repositioning, especially when other imaging is limited. Broader adoption in ICU practice could improve care, highlighting the need for training programs in critical care TEUS.
How To Cite This Article:
Isa M, Sosa FA, Bertorello-Andrade L, Roberti JE, Fernández J, Tort B, et al. Multiorgan Assessment with Transesophageal Ultrasound in Prone Ventilation Patients with Acute Respiratory Distress Syndrome: An Observational Study in Argentina. Indian J Crit Care Med 2025;29(9):731-736.
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