Orogastric tubes do not improve transesophageal echocardiographic imaging during cardiac surgery: a randomized trial

Image quality is often an overlooked consideration that affects the quality and findings of a perioperative transesophageal echocardiography (TEE) study. We undertook a study to evaluate the potential benefit of orogastric (OG) tube insertion following tracheal intubation as a method to improve TEE image quality. In this prospective randomized double-blind controlled trial, 32 adult cardiac surgery patients were randomized to receive either an orogastric (OG) tube with suctioning or no OG tube following tracheal intubation and before TEE probe insertion. Two independent observers graded the quality of related TEE images on a scale from 1 to 4, and the total image scores (total scores out of a possible 20) were compared between groups across five different views. All analyses were by intention to treat. For the total scores, there was no difference between the OG and control groups (mean 12.3 [2.1] vs 12.8 [1.8], respectively; P = 0.7). There was a numerically small but statistically significant difference in total scores between reviewers (score 2.4 [0.7] vs 2.2 [0.9]; mean difference -0.2; 95% confidence interval -0.4 to -0.02; P < 0.001). For the most part, the raters agreed on the scores for each view. Overall, 96% of the total scores were identical or differed by only one point. While this study was underpowered to detect small changes in image quality, the use of an OG tube for routine cases did not improve the overall quality of the related images acquired during TEE examination.