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.

Non-invasive cardiac output monitoring.

Outcomes in the management of critically ill patients may be improved using goal-directed peri-operative haemodynamic monitoring. A conservative approach may no longer be acceptable but in view of the significant morbidity associated with balloon tipped flow directed pulmonary artery catheters a non-invasive approach would be preferable. In this review we consider the different non-invasive techniques available and discuss the advantages and disadvantages of each technique.

Doppler-based hemodynamic monitoring: a minimally invasive alternative.

Doppler-based hemodynamic assessment affords a magnitude of diagnostic applications including evaluation of blood flow from the left ventricle. Doppler echocardiography, in the form of transthoracic and transesophageal echocardiography, allows for intermittent evaluation of hemodynamic information including aortic blood flow, global and regional wall motion, and valvular integrity. In the hands of a skilled operator, transthoracic and transesophageal echocardiography provides reliable cardiac output determinations. However, these are not considered routine for hemodynamic monitoring in the critically ill. Neither of the echocardiographic approaches provides the continuously available data needed for ongoing evaluation of response to interventions. In contrast, esophageal Doppler monitoring, a minimally invasive hemodynamic assessment tool, provides the ability for ongoing real-time hemodynamic assessment of the critically ill or compromised patient. This simple-to-use technology requires that a probe, similar in size and shape to a gastric tube, be inserted into the esophagus to obtain measurement of blood flow in the descending aorta. Hemodynamic variables such as cardiac output, preload, afterload, and contractility are measured or derived from the esophageal Doppler monitoring waveform.

Transesophageal dobutamine stress echocardiography: the nurse's role.

Transesophageal dobutamine stress echocardiography uses ultrasonic imaging of the myocardium from the esophagus and stomach during the infusion of incremental doses of dobutamine. Given the semi-invasive nature of the procedure, the nurse who assists the physician plays an essential role in the successful completion of the test. This method is useful for the evaluation of patients with coronary artery disease and for investigations based on ultrasound imaging of the myocardium. Its expanding applications emphasize the relevance of a nursing collaboration and thereby create an opportunity to increase nurses' participation in echocardiography laboratories.

Transesophageal echocardiography: implications for the critical care nurse.

TEE is an exciting and useful diagnostic tool that is rapidly gaining widespread acceptance in both teaching centers and community hospitals. Because of the semi-invasive nature of the procedure, nursing expertise is essential to ensure patient safety and comfort during the TEE examination.