ABSTRACT
Tricuspid annular plane systolic excursion (TAPSE) is a robust measure of RV function, but the performance of transesophageal echocardiography (TEE) measured TAPSE during surgery is not well established. We aim to evaluate feasibility of various TEE views before, during and after surgery. Furthermore, we compare performance of individual TEE measurements depending on view and method (AMM- and M-mode as well as 2D) as well as TAPSE measured using TEE with transthoracic echocardiography (TTE) TAPSE. The study was conducted from January 2015 through September 2016. In 47 patients with normal left ventricular ejection fraction, TEE was prospectively performed during coronary artery bypass grafting surgery. TAPSE and tricuspid annulus tissue Doppler imaging (TDI) were recorded in five different views at pre-specified time points during surgery. Data were analyzed for availability (obtainable/readable images) and reliability (intra-/inter-observer bias and precision). Finally, TEE TAPSE was compared to TTE TAPSE immediately before and after surgery. TAPSE and TDI with TEE was achievable in > 90% of patients in the transgastric view during surgery. The AM- and M-mode had the best reliability and the best correlation with TAPSE measured with TTE. The deep transgastric view was achievable in less than 50% after sternotomy, and TAPSE measured from 2D had a poorer performance compared to the AM- and M-mode. TDI demonstrated a high reliability throughout surgery. RV function can be evaluated by TAPSE and TDI using TEE during surgery. TEE values from the transgastric view demonstrated high performance throughout surgery and a good agreement with TTE TAPSE measurements.
Subject(s)
Coronary Artery Bypass , Coronary Disease/surgery , Echocardiography, Transesophageal , Tricuspid Valve/diagnostic imaging , Ventricular Dysfunction, Right/diagnostic imaging , Aged , Aged, 80 and over , Coronary Disease/diagnostic imaging , Echocardiography , Feasibility Studies , Female , Humans , Intraoperative Care , Male , Middle Aged , Prospective Studies , Reproducibility of Results , Tricuspid Valve/physiopathology , Ventricular Dysfunction, Right/physiopathology , Ventricular Function, Right/physiologyABSTRACT
The risks to patients from pathogens present on healthcare workers' (HCWs') hands are high; however, compliance with hand hygiene among HCWs is low. We devised a prospective intervention trial of a new hand-hygiene dispensing technology to improve HCWs' compliance with hand hygiene. Baseline hand-hygiene compliance was observed for three months before and after an intervention consisting of implementation of an electronic device that reminds people to comply with hand hygiene after restroom visits. Compliance in hand-hygiene performance after restroom visits increased among HCWs from 66% to 91% after the intervention.
