Feasibility and operator-reported utility of transesophageal lung ultrasound as an adjunct to resuscitative transesophageal echocardiography in the evaluation of shock: A multicenter observational study

Authors

• Vladyslav Dieiev, Advocate Health - MidwestFollow
• Pedro D. Salinas, Advocate Health - MidwestFollow
• Felipe Teran, Translational Resuscitation Sciences (TRS) Laboratory, Department of Emergency Medicine, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY
• Clark G Owyang, Division of Pulmonary and Critical Care Medicine, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY
• Dylan J. Rupska, Advocate Health - MidwestFollow
• Aniruddh Kapoor, Advocate Health - MidwestFollow
• Zubair Siddiqui, Advocate Health - MidwestFollow
• Daniel Strama DO, Advocate Health - MidwestFollow
• Cindy Ndiaye, Advocate Health - MidwestFollow
• Nathaniel A. Sands, College of Medicine, California Northstate University, Elk Grove, CA
• Aarthi Kaviyarasu, Lewis Katz School of Medicine at Temple University, St. Luke's University Health Network, Bethlehem, PA
• Katharine M. Burns, Advocate Health - MidwestFollow
• Matthew D. Tyler, Advocate Health - MidwestFollow

Recommended Citation

Dieiev V, Salinas PD, Teran F, et al. Feasibility and Operator-Reported Utility of Transesophageal Lung Ultrasound As an Adjunct to Resuscitative Transesophageal Echocardiography in the Evaluation of Shock: A Multicenter Observational Study. Crit Care Med. Published online September 4, 2026. doi:10.1097/CCM.0000000000007337

Affiliations

Aurora St. Luke's Medical Center, Advocate Christ Medical Center, Advocate Lutheran General Hospital

Abstract

Objectives: To describe the utilization, feasibility, and operator-reported diagnostic and management impact of transesophageal lung ultrasound (TELUS) integrated into resuscitative transesophageal echocardiography (TEE) for the assessment of mechanically ventilated adults with shock.

Design: Multicenter observational cohort study using prospectively collected data.

Setting: Twenty-three hospitals from the Resuscitative Transesophageal Echocardiography Collaborative Registry (rTEECoRe) network.

Patients: From 1213 registry TEE examinations, 379 met the inclusion criteria for shock evaluation or hemodynamic monitoring in mechanically ventilated adults; 96 (25.3%) of these included TELUS.

Interventions: None.

Measurements and main results: TELUS integration was associated with significantly higher operator-reported identification of shock etiology compared with resuscitative TEE alone (86.5% vs. 75.3%; odds ratio [OR], 1.95; 95% CI, 1.02-3.72; p = 0.04). Although overall clinical management changes were more frequently reported in the TELUS group, this difference did not reach statistical significance (78.1% vs. 71.7%; OR, 1.40; 95% CI, 0.82-2.41; p = 0.22). TELUS examinations were associated with longer procedure duration (median 21.5 vs.19.0 min; p = 0.01) and were predominantly performed by intensivists. Pulmonary findings, including B-lines, pleural effusions, consolidations, and A-line patterns, varied in frequency and were occasionally associated with specific respiratory or antimicrobial interventions. Procedure-related complications were rare and similar between groups.

Conclusions: In this multicenter cohort of mechanically ventilated adults with shock, adding TELUS to resuscitative TEE was associated with a higher rate of operator-reported identification of shock etiology and was feasible with minimal additional procedure time. Prospective studies with standardized TELUS acquisition and interpretation, independent adjudication, and evaluation of patient-centered outcomes are needed to define clinical scenarios of incremental value.

Type

Article

PubMed ID

42695753