• Christian Roth, Juliane Dunkel, and Michael Möller.
• Department of Neurology, Klinikum Kassel, Kassel, Germany; Department of Neurology, Philipps University of Marburg, Germany. Electronic address: roth@drk-nh.de.
• J Crit Care. 2025 Feb 1; 85: 154928154928.

PurposeTransesophageal echocardiography (TEE) may cause an increase in intracerebral pressure (ICP). Data are currently lacking.MethodsMonocentric observational study. Continuous monitoring of ICP, cerebral perfusion pressure (CPP) and mean arterial pressure (MAP) before, during, and after TEE. The first 10 patients were positioned in the left lateral position (left lateral tilt group = LLTG). Further patients were examined in the supine position (supine position group = SPG).ResultsA total of 20 patients with a median age of 59 ± 20.1 years were included in the study. The median baseline ICP was 9 ± 4.3 mmHg in LLTG and 4 ± 5.1 mmHg in SPG. Only LLTG showed a significant increase in ICP from baseline to TEE (p = 0.013). When comparing both groups, a significantly longer procedure duration was found in the positioning group (LLTG = 14.5 min versus SPG = 9.5 min; p = 0.002).ConclusionThis study is the first to investigate the effect of transesophageal echocardiography on ICP and CPP. Our data demonstrated a temporary increase in ICP during TEE probably caused by lateral positioning the patients. For patients at risk with critically elevated ICP values, TEE should only be performed in the supine position.Copyright © 2024 Elsevier Inc. All rights reserved.

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