Lung ultrasound through the oesophagus during resuscitative TEE

Design

multicentre observational cohort study using prospectively collected registry data, no randomisation or blinding

Population

379 resuscitative transoesophageal echocardiography examinations in mechanically ventilated adults with shock across 23 hospitals; 96 included lung ultrasound

Primary outcome

operator-reported identification of shock aetiology and management change

Effect

aetiology identified 86.5% versus 75.3% (OR 1.95, 95% CI 1.02-3.72, p=0.04); management change 78.1% versus 71.7% (OR 1.40, 0.82-2.41); median procedure 21.5 versus 19.0 minutes

Resuscitative transoesophageal echocardiography is established for undifferentiated shock in ventilated patients. This registry analysis asked what adding lung views through the same probe contributes. From 1,213 examinations across 23 hospitals in the rTEECoRe network, 379 met criteria for shock evaluation in ventilated adults, and 96 of those (25.3%) included transoesophageal lung ultrasound.

Operators reported identifying the cause of shock in 86.5% of studies that included lung views against 75.3% of those that did not (odds ratio 1.95, 95% CI 1.02-3.72, p=0.04). Reported management changes were commoner but not significantly so (78.1% versus 71.7%). The additional views added a median of 2.5 minutes, and complications were rare and similar between groups.

The outcome is the weakness. 'Operator-reported identification of the cause' is what the person who chose to do the extra imaging thought afterwards, in an unblinded observational cohort — a design that reliably favours the intervention. There was no independent adjudication and no patient-centred outcome. What can be taken from it is feasibility: the lung windows are obtainable through a probe already in place, they cost a couple of minutes, and they appear safe. Whether they help a patient is untested, and the authors say so.

• Treat this as a feasibility signal, not evidence of benefit
• The added views cost about 2.5 minutes with a probe already sited
• Operator-reported diagnostic confidence is not a patient outcome and favours the intervention by design
• Transthoracic lung ultrasound remains the accessible option in most Indian emergency departments
• If adopting TELUS, standardise the acquisition protocol before adding it to routine studies

The statistics, in plain English

An odds ratio of 1.95 with an interval from 1.02 to 3.72 only just excludes 1.0, so this is a marginal result resting on 96 examinations. Because operators chose whether to perform the extra imaging, the comparison is between different clinicians in different situations, not a randomised contrast: an intensivist confident enough to add lung views is likely to be more confident of the diagnosis regardless. The non-significant management-change result (78.1% versus 71.7%) is arguably the more informative one, since it is the outcome closer to what the patient experiences.

Read the rest in the app

You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.

Get Daily Doctor — free

Scan to keep reading on your phone. No account needed to start.