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Final Course
2012
Spring Series
hTEE Course Date: June 30
Chicago, IL  Contact Geeta Surti
courses@imacorinc.com
1.516.393.0970
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Unsure of what to expect at one of our hTEE courses? Here are some pictures from our course held in Iselin, NJ on May 19
 | | Jason Kennedy MD (Vanderbilt) presenting a case with image interpretation |
 | | Physicians working on an hTEE simulator |
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hTEE discussion among physicians during one of the hands-on training sessions
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Testimonial
"With pressure monitoring, there are so many assumptions. The more we use hTEE and actually see the heart, the less willing we are to rely on those pressure assumptions. . . After using hTEE for over 2 years now, we really wouldn't want to do without it."
C. Lee Parmley MD
Director, Division of Critical Care
Vanderbilt University Medical Center
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Contact Us
imacorinc.com
1-516-393-0970
or 1-877-244-0657
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*****
Should you wish to submit an article to our next monthly newsletter,
please contact:
Sheila McGarrigle at
newsletter@imacorinc.com
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hTEE - A Nursing Perspective With Rebecca Stamm
Interview with Rebecca Stamm MSN, RN, CCNS, WCC, CCRN, Hospital of the University of Pennsylvania (HUP)
Philadelphia, PA
(Excerpted, To Read the Full Interview, Click Here)
You recently wrote up a complex aortic valve replacement case involving a patient with a bicuspid aortic valve and severe aortic stenosis. How did hTEE affect your care of this patient?
Stamm: The discussions were around going to the cath lab or returning to the operating room. Once we used the hTEE, the management was more definitive. We followed the effects of the medications in real-time. This eliminated the potential costs of returning to the operating room or going to the cath lab. The main advantage of hTEE is the real-time information. In a surgical world, we value "instant gratification" and this allowed us to identify the direction of patient management instantly.
Attendings use hTEE and develop a plan of care with the team. The clinical nurses are a part of that team and have autonomy within that plan of care to make decisions. The nurses have goals of care relating to a MAP, CVP, SVO2, etc. They look at the trends of the hemodynamic monitoring and can identify issues that may be developing, such as right heart failure. The nurses bring these observations to the team and collaborate when the plan needs to be revised, which includes being an advocate for hTEE.
How do you approach the cost / benefit of the device?
Stamm: First, patient selection is important when choosing to use this device. Our team may implement a treatment or two before moving to hTEE. When those complex cases occur, hTEE is beneficial to identify the necessary treatment options that are more specific to the patient's needs. At this point in the patient's care, changes need to happen slowly and monitored closely. hTEE can provide that opportunity.
Second, in healthcare today, we need to monitor the budget more closely than ever. We are in the process of building a business case around the cost/benefit of patient care and utilization of hTEE. As part of our leadership team, the nurse manager and I collaborate to discuss the financial aspects along with the quality of care and patient outcomes related to utilization of hTEE.
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by D. L. Greenhalgh MD, M. R. Patrick MD
Consultant Anaesthetists Wythenshawe Hospital, Manchester, UK
Published in Anaesthesia March 2012
(Excerpted, To Read the Full Report, Click Here)
Transoesophageal echocardiography is the investigation of choice on the cardiac intensive care unit (and general units are catching on) as a diagnostic tool for the haemodynamically unstable patient; a category-1 indication. It is invaluable in determining the cause of haemodynamic failure and it has taught us much we did not previously realise. Among other things it has taught us to appreciate the fragility and afterload sensitivity of the right ventricle, that left ventricular outflow tract obstruction is common and can occur in otherwise normal hearts, and that hypovolaemia can occur in the presence of a high central venous pressure [16-18]. . . Transoesophageal echocardiography allows targeted early re-operation for cardiac tamponade, while decreasing the number of unnecessary re-operations for medical causes of hypotension. This has implications for both patients and trust finances, the latter important in the present climate [13, 20]. The development of a disposable probe designed for 48 hours of continuous use will, we think, be very helpful for the development of TOE as a 'routine' monitor on intensive care units. (Bold added for emphasis) Back to Top |
The Efficacy of Miniaturized TEE Imaging in the Management of a Patient S/P CABG with Hypotension and RV Failure
Nicholas C. Cavarocchi MD and Christopher Kang MD, Thomas Jefferson University Hospital, Philadelphia, PA
(Abstract, to Read the Full Case, Click Here) A 75-year-old male with low LV ejection fraction and severe CAD developed hypotension requiring an IABP before CABG. The patient had low CI (1.81 l/min/m2) post-operatively on epinephrine, milrinone, neosynephrine, and amiodarone; an EKG showed new atrial fibrillation and changes consistent with inferior wall infarction. Acute right heart failure was detected with a miniaturized 72 hour, TEE probe designed for hemodynamic management in the ICU (ClariTEEŽ, ImaCor Inc., Garden City, NY), and managed by weaning off epinephrine and increasing inodilators (milrinone) under hTEE guidance. Cardiac index improved to 2.8 l/min/m2 and bi-ventricular function became normal over 72 hours under further ClariTEE imaging-guided management. |
Managing RV Dysfunction With hTEE: A Review of User Experience
by Harold Hastings PhD, Co-Founder and Chief Technology Officer, ImaCor Inc.
Many studies have found transesophageal echocardiography (TEE) to have a significant clinical impact.1-4 One significant reason is the unique ability of TEE to assess right ventricular function, important in pulmonary perfusion and in generating adequate preload for the left ventricle, compared with limitations of indirect monitors.5
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Figure 1. The role of echocardiography in diagnosing hemodynamic instability, as described in Vincent et al.3, Figure 1.
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ImaCor Unveils The Reading Room
by Jeff Normand RDCS, Director of Marketing, ImaCor Inc.
At ImaCor we recognize that our users must constantly educate themselves on new products and methods to help manage their critically-ill patients. Our commitment to educate is a staple of our company and we continue to look for new ways to improve that education. Our customers receive a training program that begins with Clinical Specialist-led didactic discussions on TEE image acquisition, basic anatomy and system functionality. Next, we implement our HeartWorks simulator, a hands-on approach to image acquisition, in which users can learn how to accurately obtain the 3 views needed for the hTEE exam. This educational package has again taken another leap forward as we introduce the Reading Room web-based tutorial for users with little or no TEE experience.
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ImaCor Participates in ESICM's Hemodynamic Monitoring Course in Bern by Di Fitzgerald, European Director,
Clinical Operations and Business Development, ImaCor Inc.
As part of the European Society of Intensive Care Medicine (ESICM's) advanced training in critical care education series, the Hemodynamic Monitoring course was held in Bern, Switzerland on May 11 and 12. The course was chaired by Dr. Maurizio Cecconi from St. George's Hospital in London, and was sold out with 28 attendees from many different countries. It was an excellent course with some of the top European experts in Hemodynamic Monitoring as instructors, including Prof. J. Takala (Switzerland), Prof. J. Bakker (The Netherlands), Dr. A. Rhodes (United Kingdom), Dr. G. Voga (Slovenia), and Dr. H. Flaatten (Norway).
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 Hemodynamic transesophageal echocardiography (hTEE) continues to be at the forefront of contemporary thinking among key opinion leaders. There have been several leading peer-reviewed articles on the value of hTEE within the last eighteen months. D. L. Greenhalgh MD's article, which appeared in Anaesthesia in March 2012, is one of the more recent papers, and it underscores the imperative of using TEE in the ICU; she calls for using TEE continuously over a 48-hour period following surgery. Our featured case study, concerning a patient with IABP and right heart failure, describes how hTEE was essential in managing the patient's therapy, and it drives home the value of hTEE in the ICU. Harold Hastings PhD provides even more case evidence of the role of hTEE to determine and manage RV dysfunction. Many thanks to Nicholas Cavarocchi MD for his continued contribution to this newsletter. The level of teamwork and collaboration between nurses and physicians is widely known, particularly when dealing with the critically ill. We are pleased to have Rebecca Stamm MSN share her nursing perspective on how hTEE has been adopted at the Hospital of the University of Pennsylvania. Her perspective on the real-time 'instant gratification' of hTEE to direct patient management was quite interesting. Education continues to be one of our important objectives. While we complete the last of the Spring hTEE courses for 2012 on June 30 in Chicago and participate in Society-led courses like the one that took place at Bern, we are concomitantly unveiling the hTEE Reading Room as Jeff Normand describes in his article. The hTEE Reading Room is a resource administered by the Clinical Specialist and made available to the physician following training. It features a robust library of normal and abnormal images for physicians to peruse first with the Clinical Specialist, and later at their own pace. For more information on the Reading Room or to obtain hTEE training, please contact us at courses@imacorinc.com. With kind regards, Peter Pellerito President & CEO Share: |
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