David J Canty1, Johan Heiberg2, Jen A Tan3, Yang Yang4, Alistair G Royse5, Colin F Royse6, Abdulelah Mobeirek7, Fayez El Shaer7, Turki Albacker7, Rakan I Nazer7, Muhammed Fouda7, Bakir M Bakir7, Ahmed A Alsaddique7. 1. Department of Anesthesia and Pain Management, Royal Melbourne Hospital and Monash Medical Centre, Melbourne, Australia; Department of Surgery, University of Melbourne, Melbourne, Australia; Department of Medicine, Monash University, Melbourne, Australia. 2. Department of Anesthesia and Pain Management, Royal Melbourne Hospital and Monash Medical Centre, Melbourne, Australia; Department of Surgery, University of Melbourne, Melbourne, Australia. Electronic address: johan.heiberg@clin.au.dk. 3. Department of Anesthesia and Pain Management, Royal Melbourne Hospital and Monash Medical Centre, Melbourne, Australia. 4. Department of Critical Care Medicine, Western Hospital, Footscray, Melbourne, Australia. 5. Department of Surgery, University of Melbourne, Melbourne, Australia; Department of Surgery, Royal Melbourne Hospital, Melbourne, Australia. 6. Department of Anesthesia and Pain Management, Royal Melbourne Hospital and Monash Medical Centre, Melbourne, Australia; Department of Surgery, University of Melbourne, Melbourne, Australia. 7. King Fahad Cardiac Centre & College of Medicine, King Saud University, Riyadh, Saudi Arabia.
Abstract
OBJECTIVES: The use of limited transthoracic echocardiography (TTE) has been restricted in patients after cardiac surgery due to reported poor image quality. The authors hypothesized that the hemodynamic state could be evaluated in a high proportion of patients at repeated intervals after cardiac surgery. DESIGN: Prospective observational study. SETTING: Tertiary university hospital. PARTICIPANTS: The study comprised 51 patients aged 18 years or older presenting for cardiac surgery. INTERVENTIONS: Patients underwent TTE before surgery and at 3 time points after cardiac surgery. Images were assessed offline using an image quality scoring system by 2 expert observers. Hemodynamic state was assessed using the iHeartScan protocol, and the primary endpoint was the proportion of limited TTE studies in which the hemodynamic state was interpretable at each of the 3 postoperative time points. MEASUREMENTS AND MAIN RESULTS: Hemodynamic state interpretability varied over time and was highest before surgery (90%) and lowest on the first postoperative day (49%) (p<0.01). This variation in interpretability over time was reflected in all 3 transthoracic windows, ranging from 43% to 80% before surgery and from 2% to 35% on the first postoperative day (p<0.01). Image quality scores were highest with the apical window, ranging from 53% to 77% across time points, and lowest with the subcostal window, ranging from 4% to 70% across time points (p< 0.01). CONCLUSIONS: Hemodynamic state can be determined with TTE in a high proportion of cardiac surgery patients after extubation and removal of surgical drains.
OBJECTIVES: The use of limited transthoracic echocardiography (TTE) has been restricted in patients after cardiac surgery due to reported poor image quality. The authors hypothesized that the hemodynamic state could be evaluated in a high proportion of patients at repeated intervals after cardiac surgery. DESIGN: Prospective observational study. SETTING: Tertiary university hospital. PARTICIPANTS: The study comprised 51 patients aged 18 years or older presenting for cardiac surgery. INTERVENTIONS:Patients underwent TTE before surgery and at 3 time points after cardiac surgery. Images were assessed offline using an image quality scoring system by 2 expert observers. Hemodynamic state was assessed using the iHeartScan protocol, and the primary endpoint was the proportion of limited TTE studies in which the hemodynamic state was interpretable at each of the 3 postoperative time points. MEASUREMENTS AND MAIN RESULTS: Hemodynamic state interpretability varied over time and was highest before surgery (90%) and lowest on the first postoperative day (49%) (p<0.01). This variation in interpretability over time was reflected in all 3 transthoracic windows, ranging from 43% to 80% before surgery and from 2% to 35% on the first postoperative day (p<0.01). Image quality scores were highest with the apical window, ranging from 53% to 77% across time points, and lowest with the subcostal window, ranging from 4% to 70% across time points (p< 0.01). CONCLUSIONS: Hemodynamic state can be determined with TTE in a high proportion of cardiac surgery patients after extubation and removal of surgical drains.
Authors: Anders Aneman; Nicholas Brechot; Daniel Brodie; Frances Colreavy; John Fraser; Charles Gomersall; Peter McCanny; Peter Hasse Moller-Sorensen; Jukka Takala; Kamen Valchanov; Michael Vallely Journal: Intensive Care Med Date: 2018-04-30 Impact factor: 17.440
Authors: Lucia Wilke; Francisca E Abellan Schneyder; Markus Roskopf; Andreas C Jenke; Andreas Heusch; Kai O Hensel Journal: Sci Rep Date: 2018-06-15 Impact factor: 4.379
Authors: Inge T Bootsma; Thomas W L Scheeren; Fellery de Lange; Johannes Haenen; Piet W Boonstra; E Christaan Boerma Journal: J Intensive Care Date: 2018-12-27