The Use of and Preferences for the Transesophageal Echocardiogram and Pulmonary Artery Catheter Among Cardiovascular Anesthesiologists
Bibliographic record
Abstract
UNLABELLED: The pulmonary artery catheter (PAC), although widely used in anesthesia for cardiac and vascular surgery, remains controversial. Use of transesophageal echocardiography (TEE) by cardiovascular anesthesiologists may be a substitute or a preference compared with the PAC, but this has been incompletely investigated. An anonymous, cross-sectional survey was mailed to anesthesiologists in Canada and the United States. Anesthesiologists described their use of the PAC and TEE during cardiac and vascular surgery, along with their demographic characteristics. Two hundred sixty-five (77%) of 345 anesthesiologists responded. All had the PAC available for use, and 56% had TEE available. Only 23 (11% overall) reported having undergone echocardiography training, half of whom had completed fellowships. Both the PAC and TEE were more often used in cardiac valvular surgery (P = 0.0001) than in aortocoronary bypass or abdominal vascular surgery. Among all anesthesiologists, the PAC remained the preferred monitor in either cardiac or vascular surgery (P = 0.0001), although many indicated a preference for neither monitor. Among anesthesiologists with echocardiography training, TEE was preferred (P = 0.0004). We found that TEE was accessible to more than half of the surveyed anesthesiologists in cardiovascular surgery, but relatively few of them had completed formal training in its use. Only those with completed formal TEE training indicated a significant preference for TEE use and also used it frequently. Given the continuing controversy about the appropriate application of the PAC, concern about the appropriate application of TEE is prudent. The PAC remains the more frequently used and preferred monitor among cardiovascular anesthesiologists. IMPLICATIONS: A survey of anesthesiologists found that pulmonary artery catheter monitoring is currently more frequently used compared with transesophageal echocardiography during cardiac and vascular surgery.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.018 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".