TRANSESOPHAGEAL ECHOCARDIOGRAPHY IN CRITICALLY ILL PATIENTS - FEASIBILITY, SAFETY, AND IMPACT ON MANAGEMENT

Transesophageal echocardiography (TEE) is being used with increasing f requency in critically ill patients in whom transthoracic echocardiogr aphy (TTE) is often unsatisfactory in providing much needed informatio n. We reviewed the indications, feasibility, and clinical impact of TE E in the intensive care setting at our institution. TEE was performed in 77 critically ill patients (age range 19 to 83 years) in whom TTE w as inadequate or inconclusive. The general indications for performing a TEE were as follows: Hemodynamic instability (41%), possible endocar ditis (34%), possible embolic source (21%), and possible aortic dissec tion (4%). In the subset of patients with hemodynamic instability, sev ere native mitral regurgitation was the most common underlying cause ( 25%), followed by hypovolemia after cardiac surgery (22%). TEE was fea sible in all patients, 47% of whom were on mechanical ventilation. Two patients required stabilization before TEE, including a femoral arter y-to-vein bypass in a patient with shock from a prosthetic valve obstr uction. Complications, none of which proved to be fatal, occurred in t wo. Echocardiography led to a significant change in patient management in 46 of the 77 patients (60%), of which 48% was due solely to TEE. I n these patients (n = 37), the TEE findings led to a change in medical management in 19% and to surgical intervention in 29%. While TTE rema ins the first line of diagnostic ultrasound and Doppler in critically ill patients, it can be technically difficult or inconclusive. In this setting, TEE provides a safe and powerful diagnostic tool that can he lp guide patient management.