Does Transesophageal Echocardiography Along With an Orogastric Tube Improve the Image Quality Intraoperatively?

Study Overview
=================
Brief Summary
-----------------
Image quality of intraoperative transesophageal echocardiography (TEE) tends to get worse during long hours of operations. An orogastric tube (OGT) is often inserted in the beginning of the case, and left there for intermittent suction as needed, or removed before TEE exam to prevent echoic artifacts. However, if left there, the effect of suction might be limited due to unreliable tip position of the OG tube. If removed, stomach will be distended again. We devised the OG tube attached TEE for practical suction and assessed its effect on image quality intraoperatively.

Detailed Description
-----------------
OGT attached TEE probe is used for cardiac and liver transplantation cases. Each case is assigned 3 investigators who are blinded to this study design, We do image quality assessment by two methods; firstly, we categorize image quality as numbers based on each investigator's impression (1: Very bad, 2: bad, 3: acceptable, 4: good, 5: very good) and compare the difference in number before and after suctioning. Secondly, we evaluate consistency intraclass correlation coefficient (ICC) for inter-observer variability using investigator A, B and C. We evaluate absolute-agreement ICC for intra-observer variability using investigator C, who perform analysis for all images twice with a 6 to 8 months interval. This analysis was performed with left ventricular fraction area change using transgastric left ventricular short axis view.

Official Title
-----------------
Does Transesophageal Echocardiography Along With an Orogastric Tube Improve the Image Quality Intraoperatively?

Conditions
-----------------
TEE Image Quality

Intervention / Treatment
-----------------
* Procedure: Suction orogastric tube which is attached to TEE probe


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: adult cardiac surgery or liver transplant surgery Exclusion Criteria: TEE with significant wall motion abnormality or TEE contraindicated patients

Ages Eligible for Study
-----------------
Minimum Age: 18 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Diagnostic
Allocation: Non-Randomized
Intervention Model: Single Group Assignment
Masking: Triple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| No Intervention: TEE image before suction<br>Suction orogastric tube which is attached to TEE probe | |
| Experimental: TEE image after suction<br>Suction orogastric tube which is attached to TEE probe | Procedure: Suction orogastric tube which is attached to TEE probe<br>* Suction orogastric tube which is attached to TEE probe<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Image quality improvement | Subjective numbering categolization and inter- and intra-observer variance | 1 day |