Noninvasive haemodynamic monitoring and hypotension management with transesophageal duplex among mechanically-ventilated patients: An analytical study

Abstract

Introduction: Central venous (CV) line is one of the most common methods of central venous pressure (CVP) measurement and hemodynamic monitoring among patients admitted to the intensive care unit (ICU). However, its complications are not rare and are life-threatening in some cases. Recently, transesophageal duplex is frequently used to monitor the cardiac output (CO) and intravascular fluid volume of patients admitted to ICU. The present study was conducted aiming to assess noninvasive hemodynamic monitoring and hypotension management with transesophageal doppler among mechanically-ventilated patients. Methods: In this descriptive cross-sectional study, 25 patients admitted to the ICU of Imam Reza Hospital, Tabriz, Iran, were studied. CV line had been inserted into the body of the patients prior to the study for various reasons. CO was measured using esophageal duplex and also transthoracic echocardiography (TTE), and CVP was determined via esophageal duplex and CV line findings. Results: Mean CO of the patients was 4.88 ± 0.61 and 4.86 ± 0.59 l/minute measured by esophageal duplex and TTE, respectively. Hence, the difference was not statistically significant between the two methods. The mean CVPs of the patients measured by esophageal duplex and CV line were 4.94 ± 1.15 and 4.54 ± 1.04 mmHg, respectively. In addition, the left ventricular (LV) filling pressure measured by Oesophageal Doppler Monitoring (ODM) and by TTE was 9.28 ± 2.66 and 9.28 ± 2.66 mmHg, respectively. The difference for both of the mentioned variables was statistically significant but clinically negligible. Conclusion: Based on the results of this study, esophageal duplex as a less invasive, safe and precise method can replace the use of CV line among patients undergoing mechanical ventilation. This will help clinicians to obtain accurate haemodynamic data from critically ill patients and avoid unexpected complications imposed by CV line insertion.

Keywords: Doppler Echocardiography, Monitoring, Haemodynamics, Central Venous Pressure