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Intensive Care Medicine
Published in: Intensive Care Medicine 8/2007

01-08-2007 | Brief Report

End-inspiratory occlusion maneuver during transesophageal echocardiography for patent foramen ovale detection in intensive care unit patients

Authors: Apostolos Koroneos, Panagiotis Politis, Sotiris Malachias, Antonis S. Manolis, Theodoros Vassilakopoulos

Published in: Intensive Care Medicine | Issue 8/2007

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Abstract

Objective

Mechanically ventilated patients in the intensive care unit cannot cooperate to perform the Valsalva maneuver during echocardiography for detection of patent foramen ovale. We evaluated the effectiveness of the end-inspiratory occlusion maneuver to enhance detection of patent foramen ovale in this patient population.

Design

Prospective interventional study.

Setting

The 40-bed intensive care unit of a university hospital.

Patients and participants

Twenty five sedated and mechanically ventilated intensive care unit patients referred by their attending physician for bedside transesophageal echocardiography and agitated saline contrast study for detection of patent foramen ovale.

Intervention

Agitated saline contrast study with end-inspiratory occlusion maneuver.

Measurements and results

All patients underwent a complete transesophageal echocardiographic study without any complications. Reduction in right atrial cross-sectional area (from 15.80 ± 6.08 cm2 to 12.40 ± 4.63 cm2; p < 0.001) and interatrial septum deviation during the maneuver were recorded in all patients. Microbubbles imaged in the left atrium within three cardiac cycles after injection of agitated saline diagnosed patent foramen ovale in three patients. When end-inspiratory occlusion maneuver was added, patent foramen ovale was diagnosed in seven patients (McNemar χ2 = 9.33, p = 0.0023).

Conclusions

The end-inspiratory occlusion maneuver enhances the sensitivity of transesophageal echocardiography with agitated saline contrast study for diagnosing intermittent patent foramen ovale in critically ill mechanically ventilated patients.
Appendix
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Metadata
Title
End-inspiratory occlusion maneuver during transesophageal echocardiography for patent foramen ovale detection in intensive care unit patients
Authors
Apostolos Koroneos
Panagiotis Politis
Sotiris Malachias
Antonis S. Manolis
Theodoros Vassilakopoulos
Publication date
01-08-2007
Publisher
Springer-Verlag
Published in
Intensive Care Medicine / Issue 8/2007
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-007-0639-6

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