The feasibility of tricuspid annular plane systolic excursion performed by transesophageal echocardiography throughout heart surgery and its interchangeability with transthoracic echocardiography.

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.

New technology markedly improves hand-hygiene performance among healthcare workers after restroom visits.

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.

Measurements of cardiac output obtained with transesophageal echocardiography and pulmonary artery thermodilution are not interchangeable.

BACKGROUND: Echocardiography is increasingly becoming an integrated tool for circulatory evaluation in the intensive care unit and the operating room. Therefore, it is imperative to know the reproducibility of measurements obtained by echocardiography. In this study, a comparison of cardiac output (CO) measurements obtained with transesophageal echocardiography (TEE) and pulmonary artery catheter (PAC) thermodilution (TD) was carried out to test the precision, accuracy and trending ability of CO measurements obtained with TEE. METHODS: Twenty-five patients completed the study. Each patient was placed in the following successive positions: supine, head-down tilt, head-up tilt, supine, supine with phenylephrine administration, pace heart rate 80 beats per minute (bpm), pace heart rate 110 bpm. TEE CO and PAC CO were measured simultaneously. The agreement was analysed by Bland-Altman plots, and to assess trending ability, a polar plot was constructed. RESULTS: Both methods showed an acceptable precision 8% (PAC TD) and 16% (TEE). In comparison with PAC TD, the TEE was associated with a bias of -0.22 l/minute [95% confidence interval: -0.54; 0.10], wide limits of agreement (-1.73 l/minute; 1.29 l/minute), a percentage error of 38.6% and a trending ability with a radial degree of 53.6°, corresponding to a poor trending ability. CONCLUSION: In comparison, CO measurements obtained with TEE and PAC TD had wide limits of agreement, a larger percentage error than would be expected from the precision of the two methods, and a poor trending ability. Thus, TEE is not interchangeable with PAC TD for measuring CO.

Lack of agreement and trending ability of the endotracheal cardiac output monitor compared with thermodilution.

BACKGROUND: Minimally invasive monitoring systems of central haemodynamics are gaining increasing popularity. The present study investigated the precision of the endotracheal cardiac output monitor (ECOM) system and its agreement with pulmonary artery catheter thermodilution (PAC TD) for measuring cardiac output (CO) during steady state and with induced haemodynamic changes in patients scheduled for elective cardiac surgery. METHODS: Twenty-five patients were enrolled. After induction of anaesthesia, endotracheal intubation using a dedicated ECOM tube, and insertion of the pulmonary artery catheter (PAC), the patient was placed in the following successive positions: (a) supine, (b) head-down tilt, (c) head-up tilt, (d) supine, (e) supine with phenylephrine administration. CO was measured simultaneously using the ECOM and the PAC. RESULTS: Both methods showed an equally good precision < 10%. Compared to PAC TD, the ECOM system was associated with a bias in supine position of -0.45 l/min (95% confidence interval: -0.86; -0.05), limits of agreement -2.40 l/min to 1.49 l/min and a percentage error of 41.0%. There was no agreement in trending ability between the two methods, with a concordance rate of 30%, shown in a four-quadrant plot. CONCLUSION: In a direct comparison with PAC TD, the ECOM system did not show an acceptable agreement, with wide limits of agreement, a much larger percentage error than should be expected from the precision of the two methods and a very poor trending ability. Thus, the ECOM does not replace measurements done by thermodilution using a pulmonary artery catheter in cardiac surgery patients.