Transesophageal Echocardiography Not Linked With Respiratory Failure, Study Finds

The 28-day cumulative risk of respiratory failure after transesophageal echocardiography (TEE) was similar to the risk measured in those go did not undergo TEE, a procedure performed after a transient ischemic attack or stroke.

Undergoing transesophageal echocardiography (TEE) was not associated with an increased risk of subsequent respiratory failure among older patients who experienced ischemic stroke or transient ischemic attack (TIA), according to a study published in BMJ Surgery, Interventions, & Health Technologies.

As explained by the study authors, TEE is an invasive procedure performed in patients who experienced an ischemic stroke or TIA to look for potential sources of cardioembolism. While TEE is deemed generally safe, potential respiratory complications caused by the procedure are not as heavily researched.

The retrospective cohort study sought to compare patients who underwent TEE to those who did not to better understand whether TEE could be associated with increased risk of respiratory failure.

The authors collected data from 99,081 patients aged 65 and older who were hospitalized for an ischemic stroke or TIA that occurred out-of-hospital between 2009 and 2018. All patients had at least 1 year of Medicare coverage before hospitalization. Of this group, 73,733 (74.4%) experienced an ischemic stroke and 25,348 (25.6%) experienced a TIA.

The mean (SD) age in the TEE group was 75.3 (6.9) years, and 79.4 (8.3) in the no TEE group. The proportions of characteristics such as gender, race, and other comorbidities were relatively similar between the 2 groups.

Of the cohort, 4677 patients (4.7%) underwent TEE, while the remaining 94,404 did not. Additionally, 1403 (1.4%) patients were put on intubation and/or mechanical ventilation through the 28-day study period, starting the day after hospital admission.

Of the TEE group specifically, 4137 had an ischemic stroke and 540 had a TIA.

The authors said the patients with respiratory failure who required intubation or mechanical ventilation were younger but had more vascular risk factors and comorbidities than those who did not require those interventions.

The 28-day cumulative risk of respiratory failure after undergoing TEE (1.4%; 95% CI, 0.8%-2.7%) was similar to the risk measured in those go did not undergo TEE (1.4%; 95% CI, 1.4%-1.5%) (P = .84). Even after adjusting for age, sex, race, and comparing stroke and TIA diagnosis, TEE was not associated with an increased risk of respiratory failure (HR, 0.9; 95% CI, 0.6-1.2).

The authors said the study had several potential limitations, most notably the lack of data on how TEE operating techniques have changed within the time frame of this study, and how that could have a case-by-case impact.

“These unmeasured variables could confound the relationship between TEE and respiratory failure, although we found no evidence that this relationship changed by calendar year,” they said. “Finally, a complete accounting of the risks and benefits associated with TEE was not possible with the data available as we do not know the full clinical indications for TEE in each case or the yield of the TEE studies.”

However, overall, the results could help weigh the possible risks and benefits of TEE for the evaluation of ischemic stroke and TIA, they said.

Reference

Bruce SS, Navi BB, Zhang C, et al. Transesophageal echocardiography and risk of respiratory failure in patients who had ischemic stroke or transient ischemic attack: an IDEAL phase 4 study. BMJ Surg Interv Health Technol. 2022;4(1):e000116. doi:10.1136/bmjsit-2021-000116