Transesophageal echocardiography in critical care units: Henry Ford hospital experience and review of the literature

Transthoracic echocardiography is of limited value in intensive care units primarily because of mechanical ventilators, surgical wounds, and the inability to position the patient to his left side. Imaging from the transesophageal window overcomes these problems, resulting in good-quality study in these patient subsets. We performed both transthoracic and transesophageal echocardiography with color-flow Doppler tests in 121 patients in various critical care units. The transesophageal ultrasound test was valuable in identifying patients with suspected left-sided native and prosthetic valve vegetations, prosthetic mitral but not aortic valve regurgitation, native mitral and aortic valve pathology, and aortic dissection and in determining cardiac etiology of systemic emboli, hypotension, hypoxia, and heart failure. Based on transesophageal echocardiographic findings, additional information was provided in 38 (32%) patients, resulting in appropriate surgery in 22 instances. In conclusion, transesophageal echocardiography is a useful tool in evaluating critically ill patients.