Compare and contrast transthoracic and transoesophageal echocardiography in the evaluation of cardiac disease in the critically ill patient. (You may tabulate your answer)
TTE |
TOE |
|
Time lag to diagnosis |
Instantaneous |
A certain degree of delay |
Need for sedation |
None |
May need sedation |
Invasive |
No |
Minimally invasive |
Morbidity |
None |
Minimal |
Mortality |
None |
Minimal |
Image quality |
Good/excellent in non- |
Excellent in all patients |
Infection control |
Stricter infectious control |
|
Cost |
More expensive probes |
|
Native and prosthetic |
TOE is superior |
|
Aortic dissection |
TOE is superior |
|
Aortic trauma |
TOE is superior |
|
LA appendage clot |
TOE is superior |
|
Pericardial effusion |
Good |
Good |
Localised tamponade (post |
Occasionally useful |
Very useful |
The recommendations for the use of TTE or TOE have been updated in 2003. The update statement, though the "summary" of a much larger statement, is in fact an unwieldy document many pages long. A much better summary of echosonography in the ICU is presented in a review article from 2008. Thre massive 2007 Appropriateness Criteria for Transthoracic and Transesophageal Echocardiography statement was used to construct the suggested non-college answer below.
Category | TTE | TOE |
Equipment |
|
|
Time lag to diagnosis |
|
|
Need for sedation |
|
|
Invasiveness |
|
|
Absolute contraindications |
|
|
Factors affecting image quality |
|
|
Infection control |
|
|
Mortality and morbidity |
|
|
Focused assessment of the cardiac arrest patient |
|
|
Assessment of ventricular function |
|
|
Assessment of aortic dissection |
|
|
Assessment of valve function |
|
|
Assessment of septal defects |
|
|
Identification of intracardiac thrombi |
|
|
Cheitlin, Melvin D., et al. "ACC/AHA/ASE 2003 guideline update for the clinical application of echocardiography." A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASE Committee to Update the 1997 Guidelines for the Clinical Application of Echocardiography). American College of Cardiology Foundation and American Heart Association (2003).
Roscoe, Andrew, and Tim Strang. "Echocardiography in intensive care."Continuing Education in Anaesthesia, Critical Care & Pain 8.2 (2008): 46-49.
Douglas, Pamela S., et al. "ACCF/ASE/ACEP/ASNC/SCAI/SCCT/SCMR 2007 Appropriateness Criteria for Transthoracic and Transesophageal Echocardiography⁎: A Report of the American College of Cardiology Foundation Quality Strategic Directions Committee Appropriateness Criteria Working Group, American Society of Echocardiography, American College of Emergency Physicians, American Society of Nuclear Cardiology, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, and the Society for ...." Journal of the American College of Cardiology 50.2 (2007): 187-204.