Safety, Feasibility and Clinical Utility of Critical Care Transesophageal Echocardiography in Hong Kong

NCT06178471 | Not Yet Recruiting

• 1 other identifier: 20231212-006-000
• Study Type: observational
• Target: 200
• Locations: 0 countries
• Sites: N/A

Brief Summary

Critical care echocardiography is increasingly recognized as an essential skill for intensivists to achieve during their training and fellowship. It serves to provide critical information to guide clinical management in patients with hemodynamic collapse and respiratory insufficiency. While transthoracic echocardiography (TTE) could be adequate for assessment in most situations, patient factors such as body habitus, presence of chest drains and tubes, presence of thoracic surgical dressings, requirement of high ventilatory support may impede operators from obtaining satisfactory images for evaluation. Moreover, operators in TTE require time and experience for adequate skill and technique acquisition. In specific pathologies such as infective endocarditis, presence of thrombus in left atrial appendage, and evaluation of intracardiac shunts, TEE has been shown to be superior to TTE for proper and accurate diagnosis. Therefore, TEE is widely accepted as the preferred and essential modality for echocardiographic examination especially in European countries. Countries such as France and North American have included critical care TEE as a core curriculum in the critical care training pathway. In Hong Kong, only basic critical care echocardiography using TTE is required during training and in clinical practice. TEE evaluation is mostly performed in cardiac surgery units by cardiac anesthetists and in stable patients by cardiologists. Critical care TEE is seldom performed by intensivists independently for hemodynamic assessment and evaluation of cardiopulmonary failure. This study describes the safety, feasibility, and clinical utility of critical care TEE by critical care fellows in a university-affiliated institute providing tertiary care to the territory. With implementation of this essential technique in a single center, this study serves to act as a generalizable guidance to achieve an ultimate goal of incorporating this technique as core curriculum in critical care training in parts of the world where critical care TEE is not well established.

Conditions

Cardiopulmonary Failure

Keywords

Echocardiography; Transesophageal Echocardiography; Critical Care Echocardiography

Outcome Measures

Primary Outcomes (1)

• Complication of TEE use in the ICU

  TEE complications include esophageal perforation, upper gastrointestinal bleeding, loss of artificial airway, oral bleeding, dental injury, odynophagia, mortality

  Within 1 week following the TEE examination

Interventions

Transesophageal Echocardiography DIAGNOSTIC_TEST

The use of transesophageal echocardiography to diagnose cardiopulmonary failure in ICU patients with suboptimal or inadequate transthoracic echocardiography examinations.

Eligibility Criteria

• Age: 18 Years - 100 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)
• Sampling Method: Non-Probability Sample

Study Population

Patients who suffer from cardiopulmonary failure requiring intubation and invasive mechanical ventilation, who benefit from detailed hemodynamic assessment by transesophageal echocardiography.

You may qualify if:

• Age ≧ 18; AND
• Admitted to the mixed medical-surgical intensive care units of Queen Mary Hospital in Hong Kong; AND
• Intubated for invasive mechanical ventilation; AND
• Clinically indicated for transesophageal echocardiography (TEE)

You may not qualify if:

• Patient possessing absolute contraindication(s) to TEE examination according to the ASE guideline 2013:
• Perforated viscus
• Esophageal stricture
• Esophageal tumor
• Esophageal perforation
• Esophageal laceration
• Esophageal diverticulum
• Active upper gastrointestinal bleed

Sponsors & Collaborators

• Queen Mary Hospital, Hong Kong: lead

MeSH Terms

Interventions

Echocardiography, Transesophageal

Intervention Hierarchy (Ancestors)

Echocardiography; Cardiac Imaging Techniques; Diagnostic Imaging; Diagnostic Techniques and Procedures; Diagnosis; Ultrasonography; Heart Function Tests; Diagnostic Techniques, Cardiovascular

Central Study Contacts

Wincy Ng, MRCP

CONTACT

64806646; wincyngwingsze@gmail.com

Study Design

• Study Type: observational
• Observational Model: COHORT
• Time Perspective: CROSS SECTIONAL
• Target Duration: 6 Months
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Associate Consultant, Adult Intensive Care Unit

Study Record Dates

• First Submitted: December 11, 2023
• First Posted: December 21, 2023
• Study Start: September 8, 2025
• Primary Completion (Estimated): January 1, 2027
• Study Completion (Estimated): July 1, 2027
• Last Updated: October 17, 2024

Record last verified: 2024-04