Transesophageal echocardiography in prone position during severe acute respiratory distress syndrome

Patients with severe acute respiratory distress syndrome (ARDS) often require prolonged sessions of prone position (PP) because of refractory hypoxemia. Because of frequent hemodynamic impairment, use of transesophageal echocardiography (TEE) is also advocated during ARDS, but its implementation during PP has not been described yet. Our objective is to report the feasibility, tolerance, and therapeutic implications of TEE during PP for severe ARDS, and to compare it with TEE performed supine. Prospective study in the medical intensive care unit of a university hospital. A total of 34 patients with ARDS underwent TEE in PP. Probe insertion was successful in all but one patient, and vital signs did not change during insertion. All standard views and measures could be obtained, except for patent foramen ovale in one patient, and cardiac output assessment in four patients. TEE examinations were all conclusive and led to therapeutic change proposal in 23 patients (70%). TEE was performed in both supine and PP in 16 patients within a median delay of 3 days. There was no difference between the two examinations in terms of feasibility, tolerance, therapeutic implication, and image quality. In ten healthy individuals, we also explored the minimal cross-sectional area of the oropharyngeal duct with the acoustic reflection technique; it was found identical in supine and PP. TEE can be performed safely and efficiently in severe ARDS patients in PP. PP is not associated with a significant change in the oropharyngeal tract cross-section in healthy individuals.