Key result
Nurse-led Valsalva training using an MEP device cuts required attempts by ~40% vs standard education.
Why the study?
To examine the effects of preprocedural Valsalva maneuver training using a maximal expiratory pressure device on Valsalva performance and patient discomfort during transesophageal echocardiography.
Does nurse-led preprocedural Valsalva maneuver training using a maximal expiratory pressure device improve maneuver performance and reduce patient discomfort in patients undergoing transesophageal echocardiography?
Does nurse-led preprocedural Valsalva maneuver training using a maximal expiratory pressure device improve maneuver performance and reduce patient discomfort in patients undergoing transesophageal echocardiography?
Preprocedural Valsalva maneuver training with real-time visual feedback using a maximal expiratory pressure device significantly improves maneuver success and reduces observable patient discomfort during transesophageal echocardiography.
Training may reduce objective discomfort and improve VM success during TEE; leaves open need for RCTs before practice change.
Purpose: This study examined the effects of preprocedural Valsalva maneuver (VM) training using a maximal expiratory pressure (MEP) device on VM performance and patient discomfort during transesophageal echocardiography (TEE).Methods: This study used a time-lagged, posttest-only, nonequivalent control group quasi-experimental design.A total of 129 patients undergoing TEE were included in the final analysis, including 67 in the control group and 62 in the intervention group.The control group received written educational materials and standardized verbal instructions, whereas the intervention group received preprocedural VM training with real-time feedback using an MEP device.Analysis of covariance was additionally performed to adjust for potential confounders, including age, sex, education level, and previous endoscopy experience.Results: The number of attempts required for successful VM was significantly lower in the intervention group than in the control group (F = 45.07,p < .001).The VM success rate was higher in the intervention group (F = 51.52,p < .001),and interatrial septal excursion was greater in the intervention group (F = 32.46,p < .001).Nurse-observed discomfort was significantly lower in the intervention group (F = 21.73,p < .001),whereas patient-reported discomfort did not differ significantly between groups (F = 0.15, p = .701).Conclusion: Nurse-led preprocedural VM training using an MEP device may promote more effective VM performance and help reduce observable discomfort during TEE.These findings suggest that preprocedural VM training with real-time feedback may enhance patient cooperation and improve procedural efficiency.Trial Registration: Clinical Research Information Service (CRIS), KCT0008944.
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Kim et al. (2026) studied Patients undergoing transesophageal echocardiography (TEE) (n=129). Nurse-led preprocedural Valsalva maneuver training using a maximal expiratory pressure (MEP) device vs. Routine preprocedural education (written materials and standardized verbal instructions) was evaluated on Number of attempts required to achieve a successful Valsalva maneuver (MD -0.76, 95% CI -0.96 to -0.56, p=<0.001). Nurse-led preprocedural Valsalva maneuver training using a maximal expiratory pressure device significantly reduced the number of attempts required for a successful maneuver (mean difference -0.76) compared to standard education.
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