When the transesophageal echo probe goes into the trachea

Transesophageal echocardiography related complications

Transesophageal Echocardiography (TEE) is an important imaging method for the evaluation of cardiac structure and function, and it holds significant value in the clinical management of cardiovascular diseases. Unlike transthoracic echocardiography (TTE), which is non-invasive, TEE involves semi-invasive intracavity operations, leading to increasing attention to its safety and potential complications. Especially with the increasing demand for TEE applications in clinical practice and the rapid growth in the number of facilities utilizing it, the standardized application and safe operation of TEE technology have become particularly crucial. This article will review the literature and draw upon personal experience to analyze the complications and safety of TEE examinations from a technical perspective.

A case of massive hemoptysis following transesophageal echocardiogram

Introduction

Tracheal intubation leading to injury of the airway is a rare complication of transesophageal echocardiography (TEE). Tracheal trauma is not a described complication of TEE, and safety literature for this procedure remains silent on the matter. We describe the case of a patient on systemic anticoagulation and antiplatelet therapy who underwent TEE and suffered massive hemoptysis requiring bronchial artery embolization (BAE).

Case presentation

An elderly patient was admitted to the hospital with recently diagnosed atrial fibrillation and shortness of breath. The patient underwent a TEE with successful synchronized cardioversion on hospital day #2. Later that day the patient experienced respiratory distress and hemoptysis and was intubated. Oropharyngeal and gastrointestinal sources of bleeding were excluded. A bronchoscopy revealed active bleeding from an ulceration in the bronchus intermedius (BI) of the right lung. A 7 French Arndt endobronchial blocker (Cook Medical, Bloomington, Indiana) was placed and anticoagulation reversed. Bleeding stopped for two days, but then returned on hospital day #5, requiring BAE to the right bronchial artery. The procedure was successful, the patient was successfully extubated, and was discharged over the next 10 days.

Discussion

Massive hemoptysis and respiratory compromise as a result of tracheal trauma is not described in the TEE literature. This patient proved to be a difficult esophageal intubation secondary to a newly discovered Zenker's diverticulum. The risk for bleeding in this patient was higher secondary to anticoagulation with warfarin and antiplatelet therapy with ticagrelor. As in all cases of massive hemoptysis, key aspects of care in this case involved localization of bleeding, reversal of anticoagulation, and definitive management such as BAE.

Conclusions

Tracheal trauma is not a described complication of TEE, but clinicians should be mindful of this possible complication in patients receiving anticoagulation. Typical management for massive hemoptysis was successful in this patient.

Esophageal Doppler monitoring for hemodynamic assessment

This article reviews the importance of hemodynamic monitoring in adding to the clinical assessment of critically ill patients. The esophageal Doppler monitor (EDM) provides a less invasive way of obtaining hemodynamic information quickly and safely at the bedside. The concepts of Doppler signal acquisition and important nursing considerations are reviewed. Case studies are provided to understand how data from the EDM can impact patient care decisions at the bedside.