What are Predictive Factors for Difficult TEE Probe Insertion in Adult Cardiac Surgery Patients?

Transesophageal echocardiography (TEE) is extensively utilized in cardiac surgery to provide real-time, high-resolution images of the heart and its surrounding structures, contributing significantly to surgical decision-making, procedural monitoring, and postoperative outcome assessment. Recent study investigated factors predictive of difficult transesophageal echocardiography (TEE) probe insertion in adult cardiac surgery patients. The observational study involved 119 adult patients undergoing cardiac surgery, analyzing demographic variables (age, gender, BMI) and airway factors (modified Mallampati classification, modified Cormack-Lehane grading, and thyromental distance). The difficulty of TEE probe insertion was categorized into three grades, and various maneuvers were assessed for difficult insertions.

Results and Key Findings

Results showed that 30.3% of insertions were difficult, and male gender, BMI ≥30 kg/m2, Mallampati class III-IV, Cormack-Lehane grade IIb-IV, and thyromental distance <6.5 cm were significantly associated with difficult insertion. Jaw thrust was the most effective maneuver for difficult cases, used in 58.3% of instances. The study highlighted the potential complications associated with difficult TEE probe insertion, such as oropharyngeal injuries and esophageal perforation, particularly with larger 3D TEE probes. The findings emphasized the importance of identifying predictive factors to anticipate challenges and reduce complications.

Patient Characteristics and Airway Factors

The study involved ethical approval and excluded patients with contraindications to TEE probe placement. The age of participants ranged from 18 to 75 years, with a higher proportion of males. The BMI distribution showed a significant portion of overweight and obese patients. Airway characteristics, including Mallampati scores and Cormack-Lehane grading, indicated potential difficulties with TEE probe insertion. While the majority of insertions were performed without difficulty, 30.3% required intervention, with jaw thrust being the most commonly used and effective technique.

Statistical Associations

The study found statistical associations between demographic and airway factors and difficult TEE probe insertion, with Mallampati class III-IV showing the strongest association. Men, individuals with high BMI, and unfavorable airway characteristics were also significantly associated with difficulty. The use of video laryngoscopy was not required in any case, suggesting that simpler techniques were sufficient. The study provided valuable insights into the predictive factors associated with difficult TEE probe insertion, highlighting the importance of comprehensive preoperative airway assessment and the value of simple, effective maneuvers in managing insertion difficulties. The findings emphasized the need for further research to validate the results in larger, multi-center studies and explore additional predictive tools to enhance patient safety during TEE probe insertion.

Key Points

- The study aimed to identify factors predictive of difficult transesophageal echocardiography (TEE) probe insertion in adult cardiac surgery patients. It involved 119 adult patients undergoing cardiac surgery and analyzed demographic variables (age, gender, BMI) and airway factors (modified Mallampati classification, modified Cormack-Lehane grading, and thyromental distance). - Results indicated that 30.3% of insertions were difficult, with male gender, BMI ≥30 kg/m2, Mallampati class III-IV, Cormack-Lehane grade IIb-IV, and thyromental distance <6.5 cm being significantly associated with difficult insertion. Jaw thrust was the most effective maneuver for difficult cases, used in 58.3% of instances. - The study highlighted potential complications associated with difficult TEE probe insertion, such as oropharyngeal injuries and esophageal perforation, particularly with larger 3D TEE probes. It stressed the importance of identifying predictive factors to anticipate challenges and reduce complications. - Statistical associations were found between demographic and airway factors and difficult TEE probe insertion, with Mallampati class III-IV showing the strongest association. Men, individuals with high BMI, and unfavorable airway characteristics were also significantly associated with difficulty. Video laryngoscopy was not required in any case, suggesting that simpler techniques were sufficient. - The study emphasized the importance of comprehensive preoperative airway assessment and the value of simple, effective maneuvers in managing insertion difficulties. It also called for further research to validate the results in larger, multi-center studies and explore additional predictive tools to enhance patient safety during TEE probe insertion.

Reference –

Hasnain S, Shenava A, Garg I (July 10, 2024) A Study of Factors Predicting Difficulties in Transesophageal Echocardiography (TEE) Probe Insertion in Adult Patients Undergoing Cardiac Surgery. Cureus 16(7): e64256. DOI 10.7759/cureus.64256.