Thomas Kratz1, Sarah Holz2, Thorsten Steinfeldt3, Maik Exner4, Marco Campo dell'Orto5, Caroline Kratz6, Hinnerk Wulf2, Martin Zoremba7. 1. Department of Anesthesia and Intensive Care Medicine, Philipps-University of Marburg, Marburg, Germany; Department of Anesthesia and Intensive Care Medicine, Clinique Bénigne Joly, Talant, France. Electronic address: thkratz21@gmail.com. 2. Department of Anesthesia and Intensive Care Medicine, Philipps-University of Marburg, Marburg, Germany. 3. Department of Anesthesia and Intensive Care Medicine, Philipps-University of Marburg, Marburg, Germany; Department of Anesthesiology, Schwaebisch-Hall, Germany. 4. Department of Anesthesia and Intensive Care Medicine, Philipps-University of Marburg, Marburg, Germany; Department of Anesthesia, Intensive Care Medicine and Pain Therapy, Berlin, Germany. 5. Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany; Department of Cardiology and Medicine, Sportklinik Bad Nauheim, Bad Nauheim, Germany. 6. Department of Anesthesia and Intensive Care Medicine, Philipps-University of Marburg, Marburg, Germany; Department of Anesthesia and Intensive Care Medicine, Clinique Bénigne Joly, Talant, France. 7. Department of Anesthesia and Intensive Care Medicine, Philipps-University of Marburg, Marburg, Germany; Department of Anesthesia, Intensive Care Medicine and Pain Therapy, Siegen, Germany.
Abstract
OBJECTIVES: Intraoperative focused transthoracic echocardiography (TTE) is feasible and has an effect on the management of hemodynamically unstable surgical patients. Furthermore, in noncardiac thoracic surgery, TTE might provide additional information for hemodynamic treatment. Transthoracic accessibility during thoracic surgical interventions is assumed to be difficult. For patients positioned on their right side, a modified subcostal transthoracic view might be helpful. DESIGN: A prospective observational study. SETTING: Single-center university hospital. PARTICIPANTS: The study comprised 105 consecutive patients undergoing noncardiac thoracic surgery. INTERVENTIONS: Focused TTE was performed during anesthetic induction after intubation for mechanical ventilation. Intraoperative focused TTE, after positioning and draping for surgery, was attempted again for all 105 patients. Changes in patient management due to the results of the TTE were documented and analyzed. MEASUREMENTS AND MAIN RESULTS: Presurgical TTE with mechanical ventilation was applied successfully in 98.1% of 105 patients. Intraoperative imaging was successful in 90 patients (85.7%). Results of intraoperative TTE led to the modification of perioperative management in 39 patients (37.1%), 20 (22.0%) of these during surgery. CONCLUSIONS: TTE in noncardiac thoracic surgery is feasible using a modified subcostal view and has an effect on hemodynamic management in a considerable number of patients.
OBJECTIVES: Intraoperative focused transthoracic echocardiography (TTE) is feasible and has an effect on the management of hemodynamically unstable surgical patients. Furthermore, in noncardiac thoracic surgery, TTE might provide additional information for hemodynamic treatment. Transthoracic accessibility during thoracic surgical interventions is assumed to be difficult. For patients positioned on their right side, a modified subcostal transthoracic view might be helpful. DESIGN: A prospective observational study. SETTING: Single-center university hospital. PARTICIPANTS: The study comprised 105 consecutive patients undergoing noncardiac thoracic surgery. INTERVENTIONS: Focused TTE was performed during anesthetic induction after intubation for mechanical ventilation. Intraoperative focused TTE, after positioning and draping for surgery, was attempted again for all 105 patients. Changes in patient management due to the results of the TTE were documented and analyzed. MEASUREMENTS AND MAIN RESULTS: Presurgical TTE with mechanical ventilation was applied successfully in 98.1% of 105 patients. Intraoperative imaging was successful in 90 patients (85.7%). Results of intraoperative TTE led to the modification of perioperative management in 39 patients (37.1%), 20 (22.0%) of these during surgery. CONCLUSIONS: TTE in noncardiac thoracic surgery is feasible using a modified subcostal view and has an effect on hemodynamic management in a considerable number of patients.